Advocates for the elderly and health care officials in Tennessee and Georgia have differing opinions on the potential for a public long-term care insurance plan included in the health care reform bill under debate in Congress.
Proponents say the voluntary program, which would be created by the Community Living Assistance Services and Supports act, will get more people thinking about long-term care planning and lessen the burden on state Medicaid programs, which today pay the bulk of long-term care costs.
But others argue that the insurance plan would run private insurers out of the long-term care business and would be ultimately unsustainable.
Monthly premiums, estimated to range from $123 to $240, will deter young and healthy participants, leading to a program enrolling mostly the sickest people who need the most care, said Kerry DeFoe, Medicaid coordinator for Georgia's State Health Insurance Assistance Program in Northwest Georgia. The program helps elderly people navigate the complexities of Medicaid and Medicare.
"It's going to discourage a lot of people from even considering long-term care (insurance) because the cost is going to be prohibitive," she said.
Under the CLASS Act, employers would have the option of automatically enrolling their workers in the insurance plan, which would be funded 100 percent through premiums and not taxpayer money. Employees would be able to opt out.
Beneficiaries would have to wait five years after beginning to pay premiums to be eligible to receive benefits of at least $50 a day for support services.
Only 10 percent of the elderly have a long-term care insurance plan, according to researchers at the National Bureau of Economic Research.
As a wave of 78 million baby boomers begin to age into the long-term care system, planning will be crucial, said Patrick Willard, director of government relations for the Tennessee AARP.
"In most cases, when you're younger, you're not thinking about your long-term care needs," he said. "You're paying for your own health care needs. This is something that ends up getting put off and pushed aside."
But Ms. DeFoe said that baby boomers, many of whom are currently taking care of parents with overwhelming long-term care needs, are more aware of these challenges than previous generations and will seek long-term care insurance of their own.
REMOVING BARRIERS TO COMMUNITY CARE
Health care reform proposals in both the Senate and House also aim to remove barriers to home and community-based services, which many people prefer to nursing home care and are much more cost-effective for those who don't need 24-7 institutionalized care, health care officials said. The CLASS Act would primarily fund these support services.
Some federal proposals mirror efforts already under way in Tennessee to streamline access to home and community-based care services, said Patti Killingsworth, TennCare's chief of long-term care.
In 2008, TennCare was spending 98 percent of its $1.1 billion long-term care budget on nursing home care and very little on less-intensive support services such as visits from an aide who can help make meals, clean and bathe enrollees. Legislation passed that same year wants to better balance the funding and increase the number of people who can receive home and community-based services.
"It's something people want. They want to be able to stay in their homes as long as possible," Ms. Killingsworth said.
In Georgia, home and community-based services also are administered through Medicaid, which in 2009 directed 44 percent of its long-term care funding in Georgia to such services.
For 73-year-old Jimmie Lou Wooden, of Rossville, the in-home assistance has made the difference between being able to stay in her own home and having to consider nursing home care. Every other day, an aide comes to her home to clean up and help her bathe, she said.
"I don't think I could live in a nursing home. I just don't think I could," she said. At home, "I've got my little dog and we're just as happy as all get out."
The average cost of in-home services is $8,550 a year, compared to average of more than $26,000 for nursing home residency, said Carolyn Harden, coordinator Area Agency on Aging's community care service program, for the 15-county Northwest Georgia region.
But Ms. Killingsworth at TennCare said the bureau isn't counting on much financial help from the CLASS Act, particularly because the details of a final reform bill are still being hashed out. Also, estimates show that the CLASS Act would probably only save about $1 million in a given year for the $7 billion TennCare program -- "a drop in the bucket," she said.
Viston Taylor, president and CEO of Alexian Brothers Community Services in Chattanooga, a community-based adult day-care program, said changes in Tennessee and federal proposals still don't go far enough to streamline access to services covered by Medicare, such as acute medical needs, with those covered by Medicaid, such as long-term nursing home care and home health care. If all services were integrated, care could be better coordinated, he said.
Alexian Brothers Community Services is part of the federal Program of All-Inclusive Care for the Elderly, or PACE program, which is funded through Medicare and Medicaid and could be a model of how that could be implemented, Mr. Taylor said.
"Whatever ends up in the final legislation when it passes I think will (still) be somewhat fragmented, but will at least get a foot in the door in terms of improving long-term care," he said.
WHAT IS THE CLASS ACT?
Included in both the House and Senate version of health care reform bill, the Community Living Assistance Services and Supports ACT, or CLASS, would create a public long-term care insurance program that would be funded through a payroll deduction for workers over age 18. Employers would have the option of automatically enrolling their workers in the insurance plan, and employees would be able to opt out. Beneficiaries would have to wait five years after beginning to pay premiums to be eligible to receive benefits of at least $50 a day for support services.