Legislation with a potentially large impact on long term care has been lying dormant in various Congressional committees over the last 2 years. Whether these bills find their way into law this year is a matter of conjecture, but a number of Capitol Hill observers believe 2009 could be a year that sees legislation addressing shortages in skilled nurses and primary care physicians in long term care, increased Medicare and Medicaid coverage, incentives for physicians to spend more time on patient care coordination and efforts to combat the high costs of treating chronic diseases.
Although the Obama administration's plans for long term care remain vague, experts predict significant initiatives making an impact on LTC from the 111th Congress in 2009.
"I think they are going to have to address some LTC issues within the health reform mix, because really it's the white elephant in the room," says John Greene, legislative director for federal and regulatory affairs at the National Association of Health Underwriters, Washington.
Proposals to emerge are likely to include legislation introduced in the past 2 years but never voted on, such as bills to encourage home and community-based care and to extend Section 125 cafeteria plan to include consumers' spending on long term care.
Sen. Chuck Grassley, R.-Iowa, said he thinks 2009 would be the year the Section 125 idea finally becomes law, Greene notes.
Greene also points out that growing numbers of employers have added LTC insurance to their basket of voluntary benefit options. This helps people realize the LTC coverage is important, he says, even though for now at least, they have to pay for it with after-tax dollars.
"Many employers put money for long term care on the table," adds Green. "When you can do it pretax and take it with you when you leave [an employer], it makes it very attractive. Because it's income protection, people want it. And with pretax treatment, it becomes very attractive."
Both Sen. Edward Kennedy, D-Mass., and Sen. Max Baucus, D.-Mont., plan to propose important health care reform legislation. Greene thinks it is likely Baucus' legislation will be folded into Kennedy's.
Greene does not expect to see LTC provisions within any health care reform proposals, because doing so would be too expensive. "I see more private sector in the mix," he says. "Congress can't offer long term care as an entitlement when they're already headed for a train wreck with Medicare and Medicaid costs."
Medicaid already pays 49% of long term care costs now, he says.
Several bills that would increase access to home and community-based care under Medicaid, introduced in 2008, are likely to resurface in the 111th Congress, supporters say.
Congress is also being urged by groups such as the American Association of Homes and Services for the Aging to prevent the Centers for Medicare and Medicaid Services from cutting home health agencies' reimbursement by 2.75% in 2009, and to assure that Congress rejects a freeze on home health payment increases.
President-elect Barack Obama's campaign proposal for health care reform said little about LTC, although it did advocate home and community-based care options for seniors' Medicaid choices.
Obama also proposed that Medicare pay for wellness programs to reduce the incidence of chronic disease and disabilities, a program that, if implemented, could help lower LTC costs, observers note.
Some experts say, however, that the economic downturn and the growing federal deficit may stifle new health care and LTC initiatives for the near future. The new President and Congress will face deficits that could approach $1 trillion in 2009, they point out.
Still, any Democratic health care initiatives that do reach the floor of Congress are likely to pick up votes from a number of Republicans in the Northeastern states, analysts say.
A number of lobbyists on the Hill are predicting federal regulation of assisted living facilities is highly likely.
Others expect moves to cut costs of chronic care paid for by Medicare. "That will be in play because people with chronic conditions have high health care costs," says one lobbyist who asked not to be identified.
Although Medicare does not pay many LTC costs, its efforts to improve chronic care could ultimately reduce those costs overall, sources observe.
For similar reasons, legislation aimed at reducing shortages of nurses and primary care physicians in the LTC field could cut costs by improving care coordination and boosting the quality of care.
"The workforce issue, the ability to recruit and retain qualified workers, is a major contributor to long term care costs," says one lobbyist. "As boomers age, there will continue to be a need for health care and long term care workers."
Industry lobbyists hope Congress will put more money into training for health care workers, such as through community colleges.
