|
Read Steve's Professional Bio
NEW: Hear
Steve on National Public Radio's "All Things Considered."
Read the related LTC Bullet here.
Read
Steve Moses's Article
on LTC in Japan
Read
Medicaid Planning Quotes
Read the Cato Institute's "policy analysis" by Steve
Moses: "Aging America's
Achilles' Heel: Medicaid
Long-Term Care." (Link to Cato's
website version http://www.cato.org/pubs/pas/pa549.pdf
)
#############################
Updated:
Friday, January 27, 2006, 10:44 AM, (Pacific)
Dateline:
Seattle, WA
#############################
DVA MEANS "DENIED TO THE VERY AFFLUENT"
LTC COUNTDOWN: Five
days and counting to the big vote in the House on the Deficit Reduction
Act. And today we have bad
news. According to
yesterday's Kaiser Daily Health Policy Report:
"House Republican leaders on Wednesday 'had a
setback' in efforts to pass the legislation in the House, CQ Today
reports. Rep. Rob Simmons (R-Conn.)
said that he would no longer support the bill, on which the House plans to
vote on Feb.1, because of opposition from AARP, labor unions and
radiologists. However,
several additional Republican House members would have to drop support
before the legislation would fail to pass (Dennis, CQ Today,
1/25)."
That means support for this critical legislation to
save Medicaid and unleash private LTC insurance has dropped from 212 in
favor and 206 opposed to 211 in favor and 207 opposed.
If two more votes flip, the vote will end in a 209 to 209 tie, i.e.
a loss.
If you have not urged your Member of Congress to vote
for the Deficit Reduction Act, do it today.
If you've done it before, do it again!
Here's how: http://www.house.gov/writerep/,
If you'd like to reach Congressman Simmons and his
staff regarding his switch from supporter to opposer of this legislation,
you can find him and them at http://simmons.house.gov/Contact/.
Don't just hammer Representative Simmons for political
pusillanimity; explain how important saving Medicaid is for Connecticut's
neediest citizens.
#############################
LTC Comment: How
many military service veterans fail to plan for long-term care risk and
cost because they assume the Department of Veterans Affairs, the good ole
VA, will be there for them when they need it?
Think again, folks. Unless
you're poor and have a medical need directly caused by a service-related
disability, you may be out of luck already and you'll almost certainly be
denied help in the future. The
same fiscal vise that is squeezing Social Security, Medicare and Medicare
will likely crush VA LTC benefits too.
Here's another in a long list of public warnings
about the inadequacy of VA benefits.
For many more examples, see "Reasons
Why Veterans Should Not Depend on VA Benefits for Long-Term Care" in
the Center for Long-Term Care Reform's "Members Only Zone" at http://www.centerltc.com/members/veterans/main.htm.
Fair warning:
Unless
you are a dues-paying member of the Center for Long-Term Care Reform with
password-protected access to our members-only website, aka "The
Zone," you won't be able to access this and other valuable
information that we reserve for members.
To
join the Center, contact Damon at 206-283-7036 or damon@centerltc.com
or go to http://www.centerltc.com/support/index.htm
and join online. You can be
in "The Zone" today!
#############################
Veterans Affairs Department Denies Health Care
Coverage Enrollment for Many Higher-Income Veterans.
Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=34992
"The Department of Veterans Affairs in the
fiscal year that ended Sept. 30, 2005, denied enrollment for health
coverage for 263,257 higher-income veterans without service-related
injuries or illnesses as part of an effort to reduce costs, the AP/Los
Angeles Times reports. VA
suspended enrollment for such veterans in January 2003.
At the time, VA estimated that the suspension would affect about
522,000 veterans through FY 2005 for a savings of $780 million.
Rep. Lane Evans (D-Ill.), a member of the House Veterans Affairs
Committee, said that additional veterans might not have attempted to
enroll because they were aware they did not qualify for health coverage
under the suspension. According
to some lawmakers and veterans groups, Congress should allocate more funds
for the VA health care system (Gamboa, AP/Los Angeles Times, 1/24).
'There is no reason ... to give the cold shoulder to veterans who
have served our country honorably,' Evans said (AP/Arizona Daily Star,
1/25). However, others
maintain that VA must establish priorities for which veterans receive
health coverage. 'Our first
priority is to care for veterans who were hurt or disabled in service and
who need our help. We are
doing that,' Jeff Phillips, communications director for House Veterans
Affairs Committee Chair Steve Buyer (R-Ind.), said.
VA spokesperson Matt Burns added that the department provides
high-quality health care to veterans, 'particularly our newly returning
veterans, those with low incomes and those who have sustained
service-related injuries or illnesses' (AP/Los Angeles Times,
1/24)."
Source: Kaiser
Daily Health Policy Report, Wednesday, January 25, 2006
#############################
Updated:
Thursday, January 26, 2006, 10:07 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC MISCELLANY
LTC COUNTDOWN: Six
days and counting to the big vote in the House of Representatives on
budget reconciliation. Obstructionists
continue to fight against Medicaid reform.
An AP story this morning has opponents sliming advocates with a
make-believe Abramoff connection: http://www.nytimes.com/aponline/national/AP-Congress-Budget-Cuts.html?pagewanted=print.
The National Council on the Aging (NCOA), which wisely supports
home equity conversion as an alternative to and relief for Medicaid, has
published an "Action Alert" urging members to vote against
rational LTC policy reform for the same discredited reasons AARP and NAELA
publicize. Reminder:
Medicaid reform will target scarce public LTC resources to the
genuinely needy and encourage responsible LTC planning.
It will not "impose harsh penalties" or "discourage
charity" or "harm Medicaid spouses."
That's fictitious hyperbole intended to preserve a corrupt status
quo on behalf of its affluent beneficiaries.
Go to http://www.house.gov/writerep/
and urge your Member of Congress to vote in favor of the Deficit Reduction
Act.
LTC Comment: Today
we point you to a few items and sources of interest swooped into our
electronic catchment lately.
KEN DYCHTWALD. Another
of the Age Wave guru's commentaries on the states of retirement is posted
on Yahoo's Finance site this morning. Check it out at http://finance.yahoo.com/.
HOME EQUITY CONVERSION.
Find a lot of interesting stories about how to use reverse
mortgages to improve seniors' lives at www.mortgagepress.com.
Enter the authors name--AGBAMU--in the search field, fill out the
"quick registration" with your email address and zip code, and
peruse a long list of "Forward on Reverse" columns.
STATE
POLICY NETWORK'S MEDICAID EXCHANGE. For
a monthly compendium of Medicaid news and commentary, including LTC
issues, sign up at http://www.ncpa.org/sub/.
Scroll down until you see "SPN Medicaid Exchange," enter
your email address and preferred delivery format (HTML, etc.) and click
"Subscribe."
ARROGANT
MEDICAID PLANNER says his business will boom.
Go to http://smartblog.typepad.com/
and scroll down to "Medicaid Guru Dave Zumpano Gives His Take On The
New Law." This is the
guy we highlight at http://www.centerltc.com/medicaid_planning_quotes.htm
who sells a course to attorneys for $5,995 on how to triple their fees by
adding a Medicaid planning practice.
DAILY
E-ALERTS AND LTC BULLETS. Want
them in your email in-basket everyday so you don't miss a beat in the LTC
policy battles? Contact Damon
at 206-283-7036 or damon@centerltc.com,
tell him you want to join the Center, and become part of the solution.
Dues are $12.50 per month or $150 per year. That's
41 cents a day to be in the front lines of the leading spearhead for
rational LTC policy reform.
#############################
Updated:
Wednesday, January 25, 2006, 10:06 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC
Bullet: Georgetown, GAO and
Kaiser: The Bermuda Triangle
of Good LTC Policy
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 after the ***news.***
*** LTC COUNTDOWN:
Seven days and counting to the budget reconciliation vote in the
House of Representatives that can make or break Medicaid and long-term
care. A vote "for"
will yank Medicaid back from its abusers, return it to the people it is
supposed to serve, the needy, and create strong incentives for everyone
else to plan responsibly for long-term care.
Call, write, email, telegram, and yell to your Member of Congress:
"Pass this critical Medicaid reform; vote for the deficit
reduction bill." Find
and write your Rep. at http://www.house.gov/writerep/.
***
***AARP CAUGHT IN CONFLICT OF INTEREST.
Today's Wall Street Journal has a front-page article by
Sarah Lueck and Vanessa Fuhrmans titled "New Medicare Drug Benefit
Sparks an Industry Land Grab" which states:
"AARP, the powerful seniors' organization, is in the awkward
position of providing impartial advice to seniors while at the same time
selling them products. . . . The
seniors' group often draws fire for its dual role as a seniors' advocate
and a sales organization. . . . The
two sides of AARP operate separately but communicate frequently. . . .
When the AARP is considering a new product, the policy side gives
it advice about local markets, for example."
If you have an online WSJ subscription, check this story out
at http://online.wsj.com/article/SB113815997252255612.html?mod=home_page_one_us.
Otherwise, pick up a copy of the paper.
Kind of makes you wonder why AARP fights to preserve Medicaid
long-term care benefits for its affluent members on the one hand while
selling them long-term care insurance on the other.
***
LTC BULLET: GEORGETOWN,
GAO AND KAISER: THE BERMUDA
TRIANGLE OF GOOD LTC POLICY
LTC Comment: Misleading
reports published by the Georgetown University Long-Term Care Financing
Project, the Government Accountability Office (GAO), and the Kaiser Family
Foundation are being used to divert members of Congress from voting for
sensible, critically needed Medicaid eligibility reforms.
We've been asked to provide a single page of bullet
points debunking this specious research and its conclusions. That's not easy to do. The
Medicaid LTC issue is complicated and easily manipulated by policy
sophists who oversimplify it to mislead well-intentioned but unwary
decision makers.
But if you follow the links in this one-pager and
consider all the evidence and logic, you can reach only one conclusion.
To preserve Medicaid as a safety net for the poor, we must reform
it as proposed in the deficit reduction bill already passed by the Senate
and House and awaiting final confirmation by the House.
Georgetown,
GAO and Kaiser: The Bermuda
Triangle of Good LTC Policy
Propaganda masquerading as research is a disservice
to seniors, tax-payers and lawmakers.
Here's why you cannot take these sources seriously when they claim
seniors are broke, asset transfers are rare, and Medicaid should not be
reformed.
POINT:
The Georgetown Long-Term Care Financing Project claims in a paper
at http://ltc.georgetown.edu/pdfs/nursinghomecosts.pdf
that "The argument that something needs to be done about abuses of
the Medicaid eligibility rules is not supported by the facts.
The studies reviewed in this paper do not support the claim that
asset transfers are widespread or costly to Medicaid, or that restricting
Medicaid eligibility would substantially increase savings or purchases of
private long-term care insurance."
COUNTERPOINT:
The studies reviewed in the Georgetown paper show no such thing.
Georgetown completely ignores the overwhelming evidence, obvious to
anyone with eyes and ears open, that Medicaid estate planning is
commonplace, that Medicaid nursing home census is inordinately high, that
Medicaid long-term care costs are out of control, and that empirical
evidence of widespread catastrophic private spending for long-term care is
non-existent. For our proof
see "LTC Bullet: Where
There's Smoke, There's Fire," Wednesday, May 18, 2005 at http://www.centerltc.com/bullets/archives2005/558.htm.
POINT: The
Government Accountability Office concludes in a report at
http://www.gao.gov/cgi-bin/getrpt?GAO-05-968
that asset transfers made shortly before applying for Medicaid LTC
benefits average small amounts.
COUNTERPOINT: This
GAO report asked the wrong questions, used the wrong methods, searched the
wrong data, and, consequently, provides little information of value.
The important issue about Medicaid asset transfers is not what
people gave away shortly before applying for Medicaid but rather what they
owned (especially home equity) several years before needing long-term
care. That is when they could
have, should have and would have saved, invested or insured for long-term
care if Medicaid were not so easy to manipulate and obtain.
We debunked the GAO report in "LTC Bullet:
GAO on TOA Underwhelms," Wednesday, October 5, 2005 at http://www.centerltc.com/bullets/archives2005/581.htm.
POINT:
The Kaiser Commission on Medicaid and the Uninsured repeats
Georgetown's and GAO's spurious findings without acknowledging
contradictory evidence and analysis in an issue brief at http://www.kff.org/medicaid/7452.cfm.
Uncritically parroting poor research taints Kaiser's other often
excellent, objective work.
COUNTERPOINT:
Kaiser's argument in a nutshell:
many older Americans are poor, infirm and need expensive long-term
care. Therefore, we should
continue to allow affluent people to receive Medicaid while sheltering
unlimited home equity and giving away unlimited assets three years in
advance. For the antidote to
such patent nonsense, consult "Aging America's Achilles' Heel:
Medicaid Long-Term Care" at
http://www.cato.org/pub_display.php?pub_id=4376.
#############################
Updated:
Tuesday, January 24, 2006, 10:23 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC
Bullet: LTC Doubletalk
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? Details
after the ***news.***
*** LTC COUNTDOWN:
8 days and counting to the big vote on budget reconciliation
scheduled for Wednesday, February 1 in the House of Representatives.
Go to "Write Your Representative" at http://www.house.gov/writerep/
and urge your Member of Congress to vote YES on the budget
reconciliation/deficit reduction bill.
That's a vote against Medicaid planning abuse and in favor of
responsible long-term care planning. ***
*** CENTER MEMBER URGES YES VOTE on budget bill.
Here's a cc of an email message to a member of Congress that we
received this morning:
"Please
vote YES for the upcoming budget reconciliation bill! Save welfare for the truly needy! The Budget bill encouraging people to plan and save and buy
long term care Partnership policies is a good one.
Currently welfare planning is everywhere. I just got off the phone with a baby boomer who said, 'We
just put Aunt X in a nursing home in Ohio after 'getting rid of' her
money. We can do that, too!
We don't need to buy long term care insurance.'
(This couple owns two movie theaters.)
Great! How are my kids
going to pay for this guy and 77 million others who are relying on an
under-funded failing Medicaid program?
If more people see the teeth of welfare recovery and the benefits
of tax deductions and asset protection with Partnership LTC insurance, we
can turn this future around. Please
vote YES for the upcoming budget reconciliation bill!
Our
thanks to Center for Long-Term Care Reform member Barbara Hanson for
taking this action. What will
you do to enlighten members of Congress and the media? ***
***
THE CENTER FOR LONG-TERM CARE REFORM doesn't have a foundation sugar daddy
or easy money from the government. If
you value our fight for rational long-term care reform, please join and
help. To become a member, go
to http://www.centerltc.com/support/index.htm
and/or contact Damon at 206-283-7036 or damon@centerltc.com.
We'll keep you up-to-the-minute day-by-day on developments in this
edge-of-the-seat political thriller.
Think of it as "LTC-24." ***
LTC BULLET: LTC
DOUBLETALK
LTC Comment: Lately,
the media has been full of warnings from Medicaid planners.
Don't wait! Medicaid
reform is coming! Grab yours
now before it's too late! Transfer
your assets before that mean, nasty Congress closes the loopholes.
Here are some examples:
According to Rachel Silverman writing in today's Wall
Street Journal ("Limits
Loom on Nursing-Home Aid: Advisers
Urge Elderly Clients To Act Before Rules Tighten Eligibility for
Medicaid," January 24, 2006, p. D2, read it here,
subscription required for online access):
"With
proposed new rules expected to take effect next month that would toughen
eligibility for Medicaid-funded nursing-home stays, lawyers and financial
advisers are urging elderly clients to make plans now that might increase
their chances of being eligible for government aid. . . . Advisers have been scurrying to alert their clients
about the proposed new rules and are encouraging seniors to make plans now
before the legislation is likely to become law."
Who
are these legal opportunists urging their clients to jump on the
government gravy train before it's derailed?
Sleazy shysters, bottom feeders at the government trough? Heavens no. The
lawyers cited in the article are at the peak of their profession, leaders
in the National Academy of Elder Law Attorneys (NAELA).
For
example: "Bernard
Krooks, an elder-law attorney in New York, has written letters to his
clients warning them of the expected changes.
'Transfers made before the law is enacted will not be subject to
the new penalty-period rules and other new provisions,' Mr. Krooks's
letter says. His firm has
lengthened its hours to accommodate an increase in business."
Bernie Krooks is a former president of NAELA.
I sat side-by-side with him as we testified April 27, 2005 before
the House Energy and Commerce Committee.
At that time, he promised members of that key
committee, a Congressional committee that is charged with preserving
Medicaid for the truly needy, that asset transfers are no big deal and
should not be curtailed. Check
it out here.
Page 115 for Krooks' testimony; page 111 for mine.
Here's a quote from Krooks' testimony:
"Clients don’t come to me seeking Medicaid.
That is a myth." (p. 116)
Now he's making hay while the sun still shines and the Medicaid
loopholes remain open. If Medicaid planning is a myth, it has obviously been a very
profitable one.
Another example:
"Vincent
J. Russo, an elder-law attorney in Westbury, N.Y., has been giving a
series of seminars on the rule changes."
Vinnie Russo is also a past president of NAELA.
I debated him at the Cato Institute on September 7, 2005.
View our debate about Medicaid estate planning at http://www.cato.org/event.php?eventid=2307.
In our debate, Russo insisted Medicaid planning is no
big deal. Now he appears to
be squeezing every dime out of unwitting clients and taxpayers before the
practice of artificially impoverishing affluent clients becomes harder to
do.
Finally, the WSJ article mentions
"Michael Gilfix, a Palo Alto, Calif., elder-law attorney."
Gilfix is a founding member of NAELA and a big-time Medicaid
planner in the lucrative Northern California Medi-Cal market.
I've debated Gilfix publicly several times over the years.
We once appeared on opposite sides of the issue in a PBS special.
According to the WSJ article, he's helping a
client shelter a home from the (hopefully) forthcoming $500,000 limit on
Medicaid's home equity exemption. What
do you suppose a home in Palo Alto, near Silicon Valley and Stanford
University, is worth after 30 years of appreciation?
Should that home equity be used for long-term care or should
Medicaid go on protecting it for prosperous homeowners?
Think maybe divesting or sheltering that kind of
wealth has been a profitable business that Medicaid planners have fought
to preserve?
The Medicaid planners' doubletalk about Medicaid and
long-term care doesn't come exclusively from affluent lawyers taking
advantage of the welfare program. They
would be run out of town on a rail if they didn't have help from enablers
in richly endowed foundations and from the media.
Think about all the "studies" produced by
the Kaiser Family Foundation intended to show that old people have no
wealth to protect from Medicaid spend down and that asset transfers are
uncommon and small. You'll
find several examples at http://www.kff.org/medicaid/index.cfm.
If all the elderly are poor and asset transfers are
insignificant, why are the Medicaid planners fighting to preserve the
status quo? Why are AARP and
big charities running expensive ad campaigns to prevent Medicaid reform?
The truth is that older American's are the richest
demographic cohort in this country. Preserving
their wealth by taking advantage of Medicaid is lucrative for the planners
who do it, for their financially well-off clients, and for the big trade
and advocacy organizations who represent them.
But that's not to say all older Americans are rich.
Many are poor. And they are the people we should save Medicaid for as a
long-term care safety net by prying it out of the grasping hands of
Medicaid abusers. That's why
passage of the budget reconciliation bill is so critical.
The greed and narrow self-interest of Medicaid
planners and their foundation-supported cheering section would wither in
the light of objective analysis and media exposure.
Unfortunately, the Medicaid planners have seduced many analysts and
reporters who should and would criticize Medicaid planning severely if
they understood what is at stake.
Just think of all the media stories you've read that
spout the party line: don't
reform Medicaid long-term care. Watch
for those stories and when you find them, email the reporters and send
them to the "Moses LTC Blog" for the truth.
Forward our LTC E-Alerts and LTC Bullets to them and urge them to
contact me for "the rest of the story."
Stay tuned as we approach the exciting climax of this
story on February 1.
Steve Moses
#############################
Updated:
Monday, January 23, 2006, 9:33 AM, (Pacific)
Dateline:
Seattle, WA
#############################
AVOID MEDICAID AND STILL GIVE TO CHARITY
COUNTDOWN:
9 days and counting to the big vote on budget reconciliation in the
House of Representatives. This
vote will tell the tale on whether Congress and the President curtail
Medicaid planning and unleash LTC Partnerships this year.
To contact your Member of Congress and urge a "yes" vote
on the budget reconciliation/deficit reduction bill, go to http://www.house.gov/writerep/.
THIS
JUST IN: NARFE, the National
Association of Retired Federal Employees, has advised its members to
"oppose Medicaid provisions in final budget bill."
How misguided! Federal
employees, active and retired, have access to an excellent federal
long-term care insurance program. They
should support that program instead of fighting against Medicaid reform.
If there ever was a group that should and could plan responsibly
for long-term care, it is retired federal employees with their generous,
taxpayer-financed pensions. If
you are a member of NARFE or have influence on its decision makers, let
them know how irresponsible their position on this issue is and ask them
to support LTC reform by advocating in favor of the budget reconciliation
bill. (Thanks to Center for
Long-Term Care Reform supporter Barb Haselden of St. Petersburg, Florida
for tipping us to NARFE's position.)
LTC
Comment: Opposition to
Medicaid long-term care reform has crystallized around the issue of
gifting and charitable donations. Defenders
of the corrupt status quo, which encourages careless divestiture of assets
to qualify for Medicaid nursing home benefits, claim that longer and
stronger transfer of assets penalties will discourage small gifts to
grandchildren and donations to worthy charities.
But that's bunk.
Federal law is explicit on this matter. Only
assets transferred for less than fair market value FOR THE PURPOSE OF
QUALIFYING FOR MEDICAID are penalizable. Check it out in the Social
Security Act at http://www.ssa.gov/OP_Home/ssact/title19/1917.htm and
below.
"LIENS, ADJUSTMENTS AND
RECOVERIES, AND TRANSFERS OF ASSETS, SEC. 1917.
[42 U.S.C. 1396p] (c)(2)(C)(ii):
. . . (2) An individual shall not be ineligible for medical
assistance by reason of paragraph (1) to the extent that- . . . (ii) the
assets were transferred exclusively for a purpose other than to qualify
for medical assistance . . ."
But even if this protection were not in the Social
Security Act, how in the world would it be good public policy to
incentivize people to give away money to relatives or charity in order to
qualify for Medicaid? It is a perverse incentive. No wonder
people don't buy LTC insurance and end up dying in nursing homes on
welfare.
The real reason AARP and various charity
organizations are fighting Medicaid reform is that they want to keep
Medicaid for themselves and for their relatively affluent members instead
of saving it as a safety net for the poor. The people hurt most by
the existing system after the poor are middle class folks who will end up
on Medicaid instead of being able to pay privately for LTC.
But if we change the system so people retain their
wealth, stay off Medicaid, and use insurance, home equity or savings for
their long-term care, can they still donate to charity? Of course. With
responsible planning, they will have money left over after meeting their
personal obligations, including long-term care, which they can give away
to relatives, donate to charities, or pass on to anything or anybody in a
bequest.
Following is a suggestion from a reader on how to
ensure that one has something left over to bequeath:
"Linked benefit policies are often
a suitable solution for affluent clients who seek a way to gift assets to
charity or to family members. These
people seek assurance that their gifts won't leave them with insufficient
assets to pay for long-term care. The
most popular way to respond to those two needs is to use tax-qualified
linked benefit life insurance/LTC policies, which are available from a
variety of high quality insurers. A
good linked benefit policy can double, triple, or quadruple the value of
the death benefit to create a pool of money to reimburse covered LTC
expenses. The death benefit is usually paid down for initial LTC
expenses, but some linked benefit policies will still provide a residual
death benefit to beneficiaries, even if the entire LTC benefit value is
exhausted.
"People who buy linked benefit
life insurance/LTC policies cover the twin risks of:
a) Needing long-term care, or
b) Dying suddenly, without ever needing
long-term care services.
"In the first event, beneficiaries
may lose some of the death benefit, but the donor's estate is protected
from LTC expenses. In the
second event, beneficiaries receive the entire death benefit, income tax
free, and probate free."
Peter Cross, President
Delta Financial Associates, Inc.
www.deltafin.com
#############################
Updated:
Friday, January 20, 2006, 2:35 PM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC
Bullet: Opponents of Medicaid
Reform Advocate Reverse Robin Hood Policies
LTC Comment: Profiteers
on the status quo are mobilizing to stop Medicaid reform.
Fight back! Details
after the ***news.***
*** 12 DAYS AND COUNTING to the big vote on Medicaid
reform in the House of Representatives.
Read today's Bullet and contact your member of Congress daily to
support the deficit reduction, budget reconciliation bill.
*** PAR FOR THE COURSE.
In keeping with the theme of today's LTC Bullet that the
affluent often rip off programs intended to benefit the poor, here's
another example:
"The
World Bank studied the results of programs meant to help the poor and
found that even programs designed to reach poor people often end up
instead helping the better-off.
According
to the researchers:
o
In almost all of the more than 20 countries surveyed, the richest
20 percent of the population received more, or as much of, the
government's subsidized maternal and child health care services as the
poorest 20 percent.
o
Studies of Cote d'Ivoire, Ghana, Guinea, Kenya, Madagascar, South
Africa and Tanzania all have shown that government spending on health
favors upper-income groups."
Source: National Center for Policy Analysis Daily Policy Digest,
Friday, January 20, 2006, http://www.ncpa.org
Now
read today's LTC Bullet for examples of this kind of "reverse
Robin Hood" public policy that are much too close to home.
***
LTC BULLET: OPPONENTS
OF MEDICAID REFORM ADVOCATE REVERSE ROBIN HOOD POLICIES
LTC Comment: Opposition
to the budget reconciliation bill is mounting.
If re-passed by the House of Representatives in a form identical to
the version passed by the Senate last month, this legislation will
undercut Medicaid planning abuse and unleash the LTC Partnership program.
That would be a marvelous outcome because it gives
Medicaid LTC benefits back to the people who really need them and
encourages others to save, invest and insure for long-term care so they're
part of the solution to America's LTC crisis, instead of remaining the
problem itself.
But people and organizations who profit from the
existing corrupt system, which perversely rewards failure to plan for
long-term care, strongly oppose reform.
They are often backed by big bucks from foundations, government
grants, and nonprofit tax status. Or,
worse yet, they profit by diverting Medicaid benefits directly to affluent
clients for a profit.
Here are some examples of their arguments and tactics
that we've discovered in the past few days.
Thanks to Center for Long-Term Care Reform members who have brought
these coordinated attacks to our attention.
Keep 'em coming to info@centerltc.com.
A group called "Independent Sector" says on
its website at http://www.independentsector.org/programs/gr/medicaidchange.html
"Spending
Reconciliation Bill Threatens Older Americans Who Make Charitable
Donations." What is this
organization and why do they oppose Medicaid reform? Their website says "Independent
Sector is the leadership forum for charities, foundations, and corporate
giving programs committed to advancing the common good in America and
around the world." So,
why do they urge their members to oppose the reconciliation bill and
provide an email link to Congress in order to do so?
They want to preserve the current system which encourages affluent
seniors to impoverish themselves in order to qualify for Medicaid by
giving away all their money to the organization's member charities.
In essence, they steal from the poor who are dependent on Medicaid
to reward the rich for giving away wealth they should be using to pay for
their own long-term care.
For our response to these
specious arguments from charities seeking to benefit at the expense of
Medicaid, see "LTC Bullet: On
Asset Transfers, Charitable Giving and Nursing Homes," Tuesday,
January 10, 2006 either on the Moses LTC Blog at www.centerltc.com
or at http://www.centerltc.com/members/ltcbullets/index.htm
(Center members with password access only.)
Here's another example.
ACTNow is an ad hoc organization thrown together to oppose
the budget reconciliation bill. It
is running TV ads in the districts of vulnerable moderate Democrats and
Republicans urging voters to prevail on their Members of Congress to vote
down Medicaid reform. A sample follows. Check
it out at http://www.actnow.org/video/simmons_wmp_medium.php.
A voice-over announcer
tells viewers: "Your
member of Congress, [insert name], recently voted to make seniors pay more
for their health care, and [his or her vote] to cut health care will deny
nursing home care to thousands. Congress[man
or woman] [name] needs to get [his or her] priorities straight: Cutting health care to give extra tax breaks to millionaires
is just plain wrong. Tell
[name of member] it's wrong to cut health care to [name of state] seniors
to give tax breaks to millionaires."
How preposterous!
The budget reconciliation bill does exactly the opposite.
It discourages abuse of Medicaid by the well-to-do in order to
preserve the welfare program's scarce resources for people genuinely in
need.
A spokesperson for one
member of Congress victimized by these unfounded attacks responded thus:
"The truth is, these
Medicaid reforms, which were endorsed by all 50 governors, including all
22 Democratic governors, as well as by the Hartford Courant and the
New York Times, will not deny nursing home care to a single senior. These reforms give states greater flexibility and target care
for those most in need."
In the meantime, in the
midst of all this misleading political hullabaloo, some private for-profit
elder law firms are fighting Medicaid reform in their own self-interest.
They seek to make hay while the sun shines with a fire sale on
Medicaid asset transfers. Here's
a quote from a "Margolis and Associates" newsletter dated
January 16, 2006.
"With the new Medicaid
transfer rules slated to be voted into law as early as February 1st, these
last two weeks of January offer a window of opportunity for long-term care
planning. Anyone in a nursing
home or facing the prospect of nursing home care can still do so-called
'half-a-loaf' planning. Anyone
doing advance planning to protect a home or other large assets can do so
this month under the three- year look-back period.
If they wait until February, they will most likely be subject to
the five-year look-back period."
Translation:
"Last chance to grab your ailing parents' savings and put them
in a nursing home on welfare." What
a way to make a living!
In the meantime, while all
this disgraceful self-dealing is going on, where's the outrage?
Where else besides here do you get the truth?
Who else besides the Center for Long-Term Care Reform is waging
this fight?
If you think Medicaid
should be saved for the poor and affluent Americans should insure for
long-term care instead of divesting their wealth to qualify for
welfare-financed LTC, then let your voice be heard.
Find your member of the
House of Representatives at http://www.house.gov/.
Then call, write and email him or her in support of the budget
reconciliation, deficit reduction bill.
And if you value the work
we're doing, please join the Center for Long-Term Care Reform.
Go to http://www.centerltc.com/support/index.htm
or contact Damon at 206-283-7036 or damon@centerltc.com
. Thanks for your support.
#############################
Updated:
Thursday, January 19, 2006, 9:24 AM, (Pacific)
Dateline:
Seattle, WA
#############################
GAO SAYS VA MAY BE PASSING THE LTC BUCK TO MEDICAID
COUNTDOWN: 13
days and counting to the critical House of Representatives vote February 1
on the deficit reduction bill. Although
the conventional wisdom in DC is that the bill will pass, the truth is
"it's not over until it's over."
Families USA has already emailed its thousands of members urging
them to ask their Members of Congress to vote against the budget.
So, get ready for a fight. Call
and write your House member and encourage him or her to vote in favor of
Medicaid reform and LTC Partnerships.
Please let us know at info@centerltc.com
if you see ads opposing the deficit reduction bill in your local media
markets.
#############################
LTC Comment: A
new report from the Government Accountability Office focuses on challenges
the Department of Veterans Affairs (VA) faces in providing nursing home
care to Vets.
Veterans as a group are much older than other
Americans: 38 percent of Vets
are over the age of 65 compared to 12 percent of the population as a
whole. This disproportion of
elderly veterans creates daunting problems for the VA to meet their
long-term care needs.
Since June of 1999, the Center for Long-Term Care
Reform has reported 17 times in LTC Bullets, LTC E-Alerts and on The Moses
LTC Blog on "Reasons
Why Veterans Should Not Depend on VA Benefits for Long-Term Care." Dues-paying Center members with password-protected access to
our Members-Only Website Zone can review these earlier notices as well as
today's at http://www.centerltc.com/members/veterans/main.htm.
If you forget your Donor Zone codes, call or email Damon at
206-283-7036 or damon@centerltc.com
and ask him. If you are not
yet a member of the Center for Long-Term Care Reform, contact Damon to
join or join online at http://www.centerltc.com/support/index.htm.
Bottom
line: America's war veterans
are old and getting older fast. They
will need expensive long-term care in huge numbers.
The Department of Veterans Affairs has been warning for years that
it will have to ration nursing home and home care to Vets more and more on
a basis of financial need and service-related disability. Now, we learn that utilization and costs are escalating
rapidly, that the VA is struggling to figure out how to meet future LTC
needs, and that Vets may have to depend even more than in the past on
Medicaid and Medicare, two public programs that are already struggling
financially to meet the needs of their non-veteran dependents.
Lesson learned? Vets
should not count on the VA for long-term care.
Those who are able should save, invest and insure for the risk of
long-term care.
Following
are highlights from the GAO report: Government
Accountability Office, "VA Long-Term Care:
Trends and Planning Challenges in Providing Nursing Home Care to
Veterans," statement of Laurie E. Ekstrand, Director, Health Care to
the Senate Committee on Veterans Affairs, January 9, 2006, GAO-06-333T, http://www.gao.gov/new.items/d06333t.pdf.
"The
Department of Veterans Affairs (VA) operates a nursing home program that
provides or pays for veterans' care in three nursing home settings:
VA-operated nursing homes, community nursing homes, and state
veterans' nursing homes. In
addition, veterans needing nursing home care may also receive it from
non-VA providers that are not funded by VA.
VA is faced with a large elderly veteran population, many of whom
may be in need of nursing home care.
In 2004, 38 percent of the nation's veteran population was over the
age of 65, compared with 12 percent of the general population.
The Veterans Millennium Health Care and Benefits Act (Millennium
Act) of 1999 and VA policy require that VA provide nursing home care to
certain veterans."
"VA's
reported overall nursing home care expenditures in its three settings
increased from $2.3 billion to almost $3.2 billion from fiscal year 2003
through fiscal year 2005. VA
officials attributed the expenditure increase from fiscal year 2003 to
fiscal year 2005, in part, to a change in the cost accounting system used
to develop expenditure totals for each nursing home setting.
Based on VA's reported expenditures, VA-operated nursing homes
continued to account for about three-quarters of VA's overall nursing home
care expenditures in fiscal year 2005, as they did in fiscal year 2003.
In fiscal year 2005, 77 percent of nursing home care expenditures
were accounted for by VA-operated nursing homes, compared to 73 percent in
2003. VA spent the remainder
on state veterans' nursing homes and community nursing homes.
From fiscal year 2003 through fiscal year 2005, the percentage of
overall expenditures for state veterans' nursing homes declined from 15 to
12 percent and the percentage of overall expenditures for community
nursing homes declined from 12 to 11 percent.
"VA's
overall patient workload in nursing homes increased to an average of
34,375 patients per day by fiscal year 2005, 3.5 percent above the fiscal
year 2003 workload. State
veterans' nursing homes accounted for over half of VA's patient workload
in fiscal year 2005. The
workload percent is higher than the 12 percent expenditure in state
veterans' nursing homes partly because VA pays on average about one-third
of the costs for care veterans receive in state veterans' nursing homes,
compared to the full cost in other settings.
From fiscal year 2003 through fiscal year 2005, the percentage of
workload provided in state veterans' nursing homes increased from 50 to 52
percent. In contrast, the
percentage of patient workload provided in VA-operated nursing homes
declined from 37 to 35 percent. The
percentage of workload in community nursing homes stayed the same at 13
percent.
"VA
faces two key challenges in planning for the provision of nursing home
care. The first challenge is
estimating who will seek care from VA and what their nursing home care
needs will be. This includes
estimating the number of veterans that will be eligible for nursing home
care, based on law and VA policy, and the extent to which these veterans
will be seeking care for short-stay postacute needs or long-stay chronic
needs. A second key challenge
VA faces is determining whether it will maintain or increase the
proportion of nursing home care demand it meets in each of the three
nursing home settings or whether veterans will need to rely more on other
non-VA nursing home care providers that are funded by other programs, such
as Medicaid and Medicare."
#############################
Updated:
Wednesday, January 18, 2006, 11:01 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC BULLET: STATE TACKLES THE REAL LTC CHALLENGE
LTC
Comment: Most states see
long-term care as a welfare problem and fail.
A new study in New Mexico sees LTC as an entitlement problem and
recommends solutions that can succeed.
More after the ***news.***
***
14 DAYS AND COUNTING until the House of Representatives votes on the
Senate's version of the deficit reduction bill.
Passage means less Medicaid planning abuse and more private
financing of long-term care. Defeat
means more of the same: busted
budgets and poor financing of LTC. Defenders
of the corrupt status quo are mobilizing to kill this critical
legislation. We invite
readers of these LTC Bullets and the Center's LTC Blog at www.centerltc.com
to bring to our attention any media ads or stories that oppose passage.
We'll respond with logic and evidence.
Don't let them kill the single most important change in long-term
care public policy to come along in more than a decade. ***
***
WSJ COLUMN LTCi ADVICE. In
his Wall Street Journal "Getting Going" column this
morning titled "Five Strategies for Helping Your Parents --
And Getting More From Their Estate,"
Jonathan Clements recommends "To help their parents and
protect their inheritance, the [adult] children could pay part of the
[long-term care] insurance premiums."
That's a great alternative to ignoring LTC until it's too late,
hiring a Medicaid planner, expropriating the parents' wealth, and placing
them in a welfare-financed nursing home.
To
help make ends meet in retirement, Clements also recommends a traditional
home equity loan instead of a reverse mortgage with its higher closing
costs. That's dubious advice
at best because he proposes using the proceeds of the home equity loan to
pay its required monthly payments. How
long would that take to equal and exceed the higher up-front costs of a
reverse mortgage for which no monthly payments are required? ***
***
WHAT GOES AROUND COMES AROUND. In
a Wall Street Journal story January 12 titled "States, Flush
in Election Year, Loosen Up, Governors Propose Tax Cuts, Infrastructure
Projects, More School Aid, Heating-Cost Relief," Deborah Solomon
writes "Facing fat budget deficits, the Bush administration is
preparing a tight 2007 budget that squeezes most domestic programs.
Flush with cash, state governors across the country are doing the
opposite. . . . [F]iscal
experts caution that states still face expenses in the next few years that
will be a challenge, no matter how good the books look now. Among them is Medicaid, which continues to outpace the rate
of state revenue growth, according to the Kaiser Family Foundation."
Here we go again!
Hard times require responsible Medicaid reforms which are cast
overboard as soon as tax receipts go up and welfare rolls go down.
It happened just that way after the recession of the early 1990s
led to Medicaid loophole closings and mandatory estate recovery in OBRA
'93. When the economy
improved, states and feds failed to enforce the reforms aggressively and a
few years later, they were right back in the same fiscal mess.
Each time this cycle occurs we come closer to the time when aging
demographics will finally prevent the accustomed upturn after an economic
trough. Sooner or later,
Social Security, Medicare and Medicaid will overwhelm the economy's
ability to pay for them. That
day of reckoning is now no more that a decade or two away.
And because markets look forward, anticipating future problems, it
could even come much sooner. ***
*** JOIN
the Center for Long-Term Care Reform.
SUBSCRIBE to our publications.
It's simple. Just go
to http://www.centerltc.com/support/index.htm,
subscribe online, or mail in your check.
Let Damon know you're joining so he can get you all the Center's
benefits immediately. Call
him at 206-283-7036 or email damon@centerltc.com.
Help us help you "ensure access to quality long-term care for
all Americans." That is the Center's mission. ***
#############################
LTC
BULLET: STATE TACKLES THE
REAL LTC CHALLENGE
LTC
Comment: According to the
deeply entrenched "welfare paradigm" of long-term care analysis,
people are living longer, dying slower at great expense, spending down
their life savings quickly for LTC and ending up on Medicaid (public
welfare) at a cost unsupportable by taxpayers.
But
if that is true, why are most Americans in denial about the risk and cost
of LTC? Why do they routinely
go to nursing homes for care instead of using the home and community-based
services (HCBS) they prefer? Why
don't they tap the illiquid equity in their homes for LTC?
Why don't they buy private LTC insurance against the risk?
Clearly, the conventional "welfare paradigm" regarding
LTC makes no sense.
Consider
this "entitlement paradigm" analysis instead.
For the past 40 years, Americans have been able to ignore the risk
of LTC, avoid the premiums for private insurance, wait to see if they ever
need LTC, and if and when they do, somebody else pays.
If
that's true, then it makes perfect sense that most people are in denial
about LTC risk and cost, that they use Medicaid-financed nursing homes
disproportionately instead of paying privately for HCBS, that they fail to
utilize the equity in their home which Medicaid exempts in unlimited
amounts and that they don't buy LTCi.
It's not that they plan to rely on Medicaid.
Rather, they just don't think about LTC because government has paid
for most LTC for 40 years.
As
the Center for Long-Term Care Reform has explained in many reports
available at www.centerltc.com,
the welfare paradigm is demonstrably false and the entitlement paradigm is
provably true. We won't take
time here to adduce that evidence, but do check it out.
So
what? People who think
long-term care is primarily a welfare problem tend to recommend even more
government spending. But if
government interference in the LTC marketplace has caused the problem,
then adding more public funding is like dousing a fire with gasoline. It makes the problem worse, not better.
People
who think long-term care is primarily an entitlement problem tend to
recommend public policies that target scarce government resources to the
genuinely needy and encourage everyone who is able to save, invest and
insure for long-term care risk. Instead
of relying on already overwhelmed public programs, they seek to attract a
whole new source of private financing for long-term care.
We're
happy to report that the tide of public policy is finally turning away
from the old-line "welfare paradigmers" who have caused the
problem to more progressive "entitlement paradigmers" who have
the solution.
One
case in point is the deficit reduction bill lying just short of the goal
line in Congress. If it
becomes law, abuse of Medicaid for LTC will decline and private financing
alternatives like home equity conversion and private LTC insurance will
flourish. We'll have much
more on that issue as time goes on.
In
the meantime, a group of long-term care stakeholders in New Mexico has
published a report rooted deeply in the "entitlement paradigm."
They propose recommendations that could truly help save Medicaid in
that economically challenged state and improve LTC for the poor, rich and
everyone in between.
Headed
by Gerontologist
Ronald Lucchino, Ph.D., the ad hoc team that participated in this
study and/or contributed to the report included representatives of state
government, the LTC provider and insurance industries, a reverse mortgage
lender, and senior advocates.
Following is the executive summary (with footnotes omitted) of
"Alternatives to Medicaid Financing for Long-Term Care,"
published in December 2005. For
a limited time, you can access the full report on the Center for Long-Term
Care Reform's website at http://www.centerltc.com/New_Mexico_LTC_Report.pdf
.
-----------------
EXECUTIVE
SUMMARY
Medicaid
was established in 1965 with the aim of providing medical health care for
the poor and to assist those with few resources and incomes too low to
cover needed health services. Today,
Medicaid expenditures exceed the cost of Medicare and will continue to
explode. If Medicaid
entitlement programs are under-funded today, in the future, the demand for
long-term care, driven by longer life expectancy and the oncoming wave of
Baby Boomers, will exhaust the program.
Today 13% of the population is age 60 and over, by 2030 it will
increase to 20%. By 2030, New Mexico will rank fourth in percentage over age
60 (Albuquerque Journal, April 22, 2005). Steps need to be taken to
insure that Medicaid provides support to those the program was intended to
serve. There are three
approaches to insure adequate funding of Medicaid:
•
Provide full funding of Medicaid (state and federal)
•
Make Medicaid a pre-funded program such as Social Security and Medicare,
and,
•
Encourage the utilization of resources to fund long-term care before
relying on Medicaid.
This
report will focus on the utilization of resources to fund long-term care
cost.
Presently
approximately 75% of Medicaid recipients are poor adults (mostly women)
and children. But this group
accounts for only about one-third of Medicaid's costs.
The remaining 25% of Medicaid recipients are aged, blind or
disabled, and they account for two-thirds of the program's costs.
The main cost driver for this latter group is long-term care for
the elderly (age 65 and over). One reason contributing to this high cost is that Medicaid,
in part, has become long-term care insurance for the middle social
economic class.
Medicaid
was never intended to be "long-term care insurance for the middle
class" as it has become. As
long as it remains "inheritance insurance" for the baby boom
generation, Medicaid will continue to fail in its first responsibility--to
provide a long-term care safety net for the disadvantaged. This will be
exacerbated as the Baby Boomers begin to age beyond 65.
CMS
(Centers for Medicare and Medicaid Services) noted that the Medicaid
program will only be sustainable if its resources are not drained to
provide health care assistance to those with substantial ability to
contribute to the costs of their own care.
A
shift in the Medicaid funding paradigm is needed to encourage individuals
who have the financial resources to take personal responsibility for their
long-term care. The NGA
[National Governors Association] recommendations to promote such a shift
are:
•
Strengthen asset transfer rules;
•
Use incentives and education to increase public awareness to use
"alterative financing" to offset long-term Medicaid costs;
•
Increase cost sharing for beneficiaries with annual incomes above the
federal poverty level;
•
Streamline the Medicaid waiver application process for states;
•
Allow states to offer different benefit packages depending upon
beneficiaries' health; and
•
Pro-actively position states to immediately implement the federal
Long-term Care Insurance Partnership programs once the federal government
removes the restriction prohibiting the states from implementing the
program.
This
paradigm shift recommended for New Mexico is not directed at our current
older adult population, but intended for those age 60 and younger.
The well-publicized aging of the Baby Boomer generation threatens
to place considerable stress on our state's long-term care system,
specifically, the publicly financed Medicaid program.
The state must fortify itself on impending need for long-term care
services by ensuring that citizens who have the means to finance a portion
or all of their long-term care services also possess the tools to do so.
It will take time and education to bring about this change.
Nationally
and locally, it has become recognized that changes must occur in the
current Medicaid funding paradigm to:
a)
keep Medicaid solvent and reduce the cost burden to states; and,
b)
insure adequate funds are available to assist those with few
resources and limited incomes by either pre-funding Medicaid, fully
funding Medicaid, utilization of ones resources prior to accessing
Medicaid, or posthumous financing through estate recovery.
Pre-funding
and fully funding Medicaid are the purview of the federal government and
are not being considered. Therefore
changes in the funding paradigm must focus on how to:
A.
Re-direct personal assets in estate planning to support long-term
care, and
B.
Enhance estate asset recovery programs as a disincentive to asset
transfer.
Our
state should consider embarking on a new mission that is proactive by
encouraging those who are soon-to-age or at risk for disability to focus
on preparations for their needs. This
preparation includes the state's critical involvement in identifying,
characterizing, and educating the citizenry about the various private
financing models available in the marketplace.
Perhaps, most importantly, the individual autonomy promoted by
private financing mechanisms is the ultimate expression of self-direction.
#############################
Updated:
Tuesday, January 17, 2006, 10:12 AM, (Pacific)
Dateline:
Seattle, WA
#############################
STATE LTCI TAX INCENTIVE UPDATE PLUS
LTC
Comment: Information updates
of interest to LTC specialists follow below.
But first, House Speaker Dennis Hastert has scheduled a vote on the
FY 2006 budget reconciliation (deficit reduction) bill for February 1,
2006. That's 15 days and
counting.
This
is the critical legislation for long-term care financing that passed both
houses of Congress at the end of last year's session, but which must be
passed again by the House of Representatives before it can become law.
For details, see our December LTC Bullets titled "Good
News, Bad News" and "LTC Denouement" in the Center for
Long-Term Care Reform's Members-Only Website Zone.
Why
is this legislation critical? It
unleashes the LTC Partnership program and reins in wasteful Medicaid
estate planning abuse. Nothing
done by Congress or the States in the past dozen years comes close to this
legislation's potential to improve long-term care financing.
It will relieve Medicaid and supercharge private insurance and home
equity conversion.
But
not everyone agrees. AARP,
the Medicaid planners at NAELA, and some other confused or misguided
groups are mobilizing to oppose passage of the deficit reduction bill. They are fighting to protect the status quo which allows
their affluent members and clients to capture Medicaid's scarce LTC
resources, which were intended for the poor.
They're targeting moderate Democrats and Republicans who favor
responsible Medicaid and LTC reform.
So,
we need your help. Please
email us examples of any ads you find in your local media that oppose
passage of the budget reconciliation/deficit reduction bill or attack
members of Congress who support the legislation.
Please use fax (206-283-6536) or snail mail only if email isn't
possible. We'll publicize
what you send us and tell the other, true side of the story.
15
days and counting toward a critical vote for the future of long-term care.
------------------
Now, here's some new information of interest.
Hyperlinks directly to all this information were provided this
morning in our daily LTC E-Alerts to Center for Long-Term Care Reform
members. All our daily
publications and information of this kind are archived in the Center's
Members-Only password-protect website Zone.
You'll find it quickly and easily weeks or months from now when you
remember it is available but you've forgotten where to find it.
To join the Center for LTC Reform and receive
everything we publish on a real time basis, contact Damon at 206-283-7036
or damon@centerltc.com.
He'll have you in the Zone and in the know usually within hours.
Or go to http://www.centerltc.com/support/index.htm
to join and subscribe online. Then
contact Damon and let him know you've contributed so he can assign your
user name and password and start the LTC E-Alerts and LTC Bullets coming
to you immediately.
------------------
STATE
BY STATE HEALTH FACTS: The
Kaiser Family Foundation has updated its statehealthfacts.org
website. For much new and
interesting health data, go to http://www.statehealthfacts.org/r/whatsnew.html.
STATE LTCi TAX INCENTIVES:
Of particular interest is an update to 2004 of states with tax
incentives for LTC Insurance, 29 at latest count. You'll find a clickable map of the United States that will
take you instantaneously to the relevant information for any state you
choose.
LTC FINANCING TUTORIAL:
Kaiser has also posted a new, 13.5 minute online tutorial about LTC
Financing. It includes a
PowerPoint-like presentation of elementary information about long-term
care delivery and financing. That
part's fine, but the second half of the program leaves much to be desired.
Shortcomings: this
slanted tutorial gives no hint of Medicaid's poor reputation for problems
of LTC access, quality, reimbursement, discrimination and institutional
bias. In keeping with
Kaiser's anti-private financing bias, this program is very negative toward
LTC insurance suggesting it is too expensive for most people and not a
viable financing option for very many.
The tutorial advocates expanded government financing of long-term
care instead of responsible LTC planning.
#############################
Updated:
Friday, January 13, 2006, 10:27 AM, (Pacific)
Dateline:
Seattle, WA
#############################
THE RETIREMENT MINDSCAPE
LTC Comment: Ken
Dychtwald's late '80s best seller Age Wave educated and impassioned
me, and probably many of you, about aging demographics. We've kept you posted over the years about his latest books
and projects. Here's what's
new.
Ken Dychtwald's latest book,
co-authored with Daniel J. Kadlec, The Power Years: A
User's Guide to the Rest of Your Life, is on the bookstands now.
But let's focus today on his most recent
"Reinventing Retirement" column on Yahoo titled "Mapping
Retirement's Mindscape." Following
are some excerpts to give you the flavor, but read the whole thing at http://finance.yahoo.com/columnist/article/retirement/2209?p=1
and follow the series at http://finance.yahoo.com/.
#############################
Ken Dychtwald, Ph.D., "Mapping Retirement's
Mindscape," January 12, 2006, http://finance.yahoo.com/columnist/article/retirement/2209?p=1.
"Retirement isn't a single event that takes
place in a day, or even in a year. In
fact, people migrate through distinct and predictable stages of
retirement, each with its own set of emotions and needs.
These stages were mapped out by the Ameriprise New Retirement
Mindscape study, an in-depth examination of the retirement experience from
a psychological and emotional point of view that my company, Age Wave,
conducted for Ameriprise Financial.
"Working with leading market research firm
Harris Interactive, we surveyed 2,000 people around the country from every
social, racial, and economic sector.
Respondents were 40 to 75 years old, since we sought to interview
people within 15 to 20 years on either side of retirement.
"The research, the first comprehensive study to
go beyond the numbers and delineate retirement stages, will help people
prepare emotionally and financially to make each phase as positive and
empowering as possible. The
stages are as follows:
"Stage 1 -- Imagination
"This first phase tends to occur 15 to 6 years
prior to retirement day. For
people in this stage, retirement is not necessarily at the top of their
minds. Many other things
probably take precedence -- career pursuits, putting children through
college, empty-nesting, paying the bills. . . .
"Stage 2 -- Anticipation
"In the five years before retirement, reality
starts to set in. This is a
time of great excitement and hopefulness.
Plans for recreation, new hobbies, family, and even post-retirement
careers begin to coalesce. There's
an exciting sense of impending liberation and promise. . . .
"Stage 3 -- Liberation
"This is retirement's honeymoon stage -- a time
of great enjoyment, enthusiasm, and hopefulness.
When asked how they felt on their 'retirement day,' respondents
said they were enormously excited and relieved.
Liberated from many cares, worries, and responsibilities, they feel
that they're living out their retirement dream.
Though they admit they miss their friends and social connections
from work, they're reconnecting with their spouses and families, pursuing
hobbies, traveling, even starting new businesses. . . .
"Stage 4 -- Reorientation
"Reorientation sets in as people realize that
retirement is often more challenging or just different from what they
expected. Health and
financial worries weigh heavily. Many
people complain of depression and boredom. . . .
"Stage 5 -- Reconciliation
"In retirement's later years, many enter a phase
of relative contentment as they ultimately come to terms with their lives.
As people reach this stage, they begin to set their sights on the
possibility of moving to a new home or location.
While they report lower levels of depression and worry, they're
also more likely to grapple with sadness as they confront end-of-life
issues among friends and family. . . .
"One of the big advantages that this Retirement
Mindscape map offers is that it allows us to more effectively understand
-- and prepare for -- the terrain ahead, and more precisely chart a course
to each of our own personal retirement dreams.
For more details about this study and its findings, go to http://www.ameriprise.com/amp/global/press-center/press-release-47.asp."
#############################
Updated:
Thursday, January 12, 2006, 11:21 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC
BULLET: SO WHAT IF THE
GOVERNMENT PAYS FOR MOST LTC? . . . 2004 DATA UPDATE
LTC Comment: Heads
up! We're about to explain
why long-term care insurance sales have disappointed and why the nursing
home and assisted living businesses are in such a woeful financial
condition. After the
***news.***
*** GOOD NEWS, BAD NEWS.
According to Congress Daily:
"House Speaker Hastert has tentatively set a vote Feb. 1 on a
$39.7 billion five-year deficit reduction package to finish action on the
bill after a procedural maneuver by Senate Democrats late last month
kicked the measure back to the House."
That vote will take place the day after President Bush's State of
the Union Address on January 31 and five days before he sends the Fiscal
Year 2007 budget to the Hill. Proponents
of the deficit reduction bill "expect to narrowly approve the bill
again," said Congress Daily.
That's the good news.
Here's the bad news.
"AARP and the Emergency Campaign for America's Priorities--an
umbrella organization representing labor and student groups and low-income
advocates--are rolling out new ad campaigns in the next two weeks"
opposing passage. What a
farce! These profiteers on
poverty don't help the poor by fighting against Medicaid reform.
Their goal is to preserve the status quo which siphons scarce,
critically needed public assistance funds into the pockets of their
affluent members by means of Medicaid planning abuse.
We'll keep you apprised of developments as this public policy
cliffhanger approaches its climax. ***
*** HALF OF GDP GOBBLED BY ENTITLEMENTS AND INTEREST
IN 2050. "The Christian
Science Monitor on Tuesday examined how some experts have raised
concerns that Medicare, Medicaid and Social Security might represent a
'fiscal time bomb' for the U.S. and that large 'tax hikes and benefit cuts
may be needed' to address the issue.
For example, recent reductions to Medicare spending approved by
Congress are 'a drop in the bucket' compared with the cost of the new
prescription drug benefit, and program trustees have estimated that the
Medicare trust fund will become insolvent by 2020, the Monitor reports.
In addition, the Congressional Budget Office has estimated that
Medicare, Medicaid, Social Security and interest on the national debt
could account for half of the U.S. gross domestic product by 2050."
(Source: Kaiser Daily
Health Policy Report -
Wednesday, January 11, 2006)
LTC BULLET: SO
WHAT IF THE GOVERNMENT PAYS FOR MOST LTC?, 2004 DATA UPDATE
LTC Comment: Once
a year around this time the Centers for Medicare and Medicaid Services
(CMS) report health care expenditure data for the latest year of record.
Recently, CMS posted 2004 statistics on its website.
The current issue of Health
Affairs (Vol. 25, Issue 1, pps. 186-196) contains a summary and
analysis of the new data titled "National
Health Spending in 2004: Recent Slowdown Led by Prescription Drug Spending."
We
give you hyperlinks to all this information in our annual analysis of the
new nursing home and home health care data.
Titled "So What If the Government Pays for Most LTC?,
2004 Data Update" and written by Center president Steve Moses, this
is probably the most important article we publish all year.
Ever wonder why LTC insurance sales and market
penetration are so discouraging? Or
why LTC service providers are always struggling to survive financially and
still provide quality care? You'll
find the answers in "So What If the Government Pays for Most LTC?,
2004 Data Update."
But you won't find this critical information here on
our public LTC Blog. This is
valuable proprietary analysis that gives members of the Center for
Long-Term Care Reform a competitive edge.
If you want it and everything else we publish, then please join the
Center as a dues-paying member.
Center members will receive today's LTC Bullet:
So What if the Government Pays for Most LTC? . . . 2004 Data
Update" in their email in-baskets this morning, just as they receive
the Center's critical, current analysis every business day.
So,
hone your competitive edge. Join
the Center today and we'll have "So What If the Government
Pays for Most LTC?, 2004 Data Update" in your hands by close of
business. You'll also gain
password-protected access to our Members Only Zone at www.centerltc.com.
We'll send you daily LTC E-Alerts if you want them.
And you'll be part of the LTC public policy solution for which we
fight tirelessly every day.
To join the Center for Long-Term Care Reform, contact
Damon at 206-283-7036 or damon@centerltc.com.
Or simply go to http://www.centerltc.com/support/index.htm
and follow directions. Simplest
of all, drop a check for $150 annual dues in the mail to the Center for
Long-Term Care Reform, 2212 Queen Anne Avenue North, #110, Seattle,
Washington, 98109. If you let
us know your check is on the way, we'll start your benefits coming
immediately.
Interested in a corporate or organizational
membership to the Center for Long-Term Care Reform so that everyone in
your company or group can receive the benefits of Center membership?
Here are the rates:
1
to 10 employees or associates: $1,000
10 to 50 employees or associates: $2,500
50 to 100 employees or associates: $5,000
100+ employees or associates: $10,000
Don't
wait. Join the Center today!
#############################
Updated:
Wednesday, January 11, 2006, 10:54 AM, (Pacific)
Dateline:
Seattle, WA
#############################
NEW LTC DATA FROM CMS
LTC
Comment: No doubt you've seen
the latest headlines about health care spending in the U.S.
Up 7.9 percent to $1.9 trillion in 2004!
$6,280 per person! 16
percent of GDP! Yet the pace of health spending growth "has
slowed!" Small
comfort that the rate of health spending growth has "slowed" to
an economically unsustainable pace far above general inflation.
These
headlines and stories came from an annual report of health and LTC
expenditures made by CMS and published each year by the journal Health
Affairs. Every year when
this new data comes out, we publish an analysis of the new LTC
expenditures titled "So What if the Government Pays for Most
Long-Term Care?" Center
members will receive that update for the latest 2004 data in tomorrow's LTC
Bullet.
Today,
we bring you excerpts from the Health Affairs article with the
details on nursing home and home care expenditures in 2004. The source is Cynthia Smith, et al., "National
Health Spending in 2004: Recent
Slowdown Led by Prescription Drug Spending," Health Affairs,
Vol. 25, Issue 1, pps. 194-195. Registered
subscribers to Health Affairs can access the full text of the
article online at http://content.healthaffairs.org/cgi/content/full/25/1/186.
Excerpts
with footnotes omitted:
"Home
health services. Spending for
freestanding home health agencies rose more rapidly in 2003 and 2004 than
any other service category (11.1 percent and 13.3 percent, respectively).
Home health spending has remained a small but growing portion of
PHC [personal health care] spending (2 percent in 2004).
In 2004, public spending rose 17.6 percent and accounted for 74
percent of home health spending. The
largest payer, Medicare, accounted for 38 percent of home health spending
in 2004, up from just 26 percent in 1999, a year influenced by BBA
[Balanced Budget Act] imposed payment cuts.
Double-digit growth in Medicare spending for home health services
in recent years, including a 19.3 percent increase in 2004, stems in part
from rapid growth in home-based hospice services, which grew an average of
27 percent per year between 2000 and 2004.
In 2000 these services accounted for 29 percent of Medicare
spending for home health, but by 2004 they had reached 39 percent, or $6.5
billion. Medicare spending
for freestanding home health services (excluding hospice) has grown an
average of 12.5 percent since the PPS began in 2000.
"Nursing homes.
Spending for services provided by freestanding skilled nursing
facilities (SNFs) rose 4.3 percent in 2004 to $115.0 billion, more slowly
than its peak growth of 6.6 percent in 2001 and nearly unchanged from its
increase in 2003.
"Medicaid is the largest public source of
funding for SNFs and accounts for nearly 40 percent of such spending
(Exhibit 5). Medicaid nursing
home spending growth decelerated from 5.3 percent in 2003 to 3.0 percent
in 2004. Spending was
influenced by the upper payment limit (UPL) financing methods that had
greatly affected Medicaid spending in 2000–2002.
Since then, use of UPL [upper payment limit] funds has been
restricted, slowing Medicaid spending for nursing homes from an average
5.9 percent annual growth during 2000–2002 to growth in 2004 that is
close to the average 3.2 percent growth experienced in 1994–1999.
As treating patients in noninstitutional settings has become a
policy imperative, use of home and community-based waivers has grown at
double-digit rates since 1998.
"In
contrast to the deceleration in Medicaid spending for nursing home care,
Medicare spending for this sector increased 7.4 percent in 2004, following
5.7 percent growth in 2003. Lower
Medicare payment rates were in effect in 2003 following the expiration of
temporary add-ons to Medicare funding, which contributed to the
double-digit growth in 2000–2002.
Medicare spending has outpaced other payers’ spending growth for
nursing homes for the past several years. Thus, Medicare accounted for 14 percent of nursing home
spending in 2004, up from 10 percent in 1999."
#############################
Updated:
Tuesday, January 10, 2006, 11:13 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC
Bullet: On Asset Transfers,
Charitable Giving and Nursing Homes
LTC Comment: Concerns
that new Medicaid eligibility rules pending final passage in Congress
could hurt charitable giving and nursing homes' finances are
understandable but mistaken. More
after the ***news.***
*** 600TH BULLET. Today's is our 600th LTC Bullet since we began
publishing on May 15, 1998. To
keep them coming, we could sure use your support.
To join the Center for Long-Term Care Reform, go to http://www.centerltc.com/support/index.htm
or contact Damon at 206-283-7036 or damon@centerltc.com.
Help us achieve the Center's mission:
universal access to top quality long-term care for all Americans.
***
*** THE
6TH ANNUAL INTERCOMPANY LTCI CONFERENCE is coming up in Anaheim, CA from
Sunday, February 26th through Wednesday, March 1st. This is "the big one" for anyone who cares about
saving the Medicaid safety net and improving LTC for everyone.
Find complete information at www.ILTCIconf.org.
Center for Long-Term Care Reform president Steve Moses will attend,
present, and cover the conference for LTC Bullets. ***
***
"ALMOST HOME" FOLLOW UP.
A dedicated LTC Bullets reader offers the following about a
forthcoming PBS special we highlighted recently:
"I went to the Almost Home and PBS websites.
The listing for Almost Home indicates it will air at 10 PM Eastern
Time on February 21st. On
the Almost Home website at www.almosthomedoc.org,
they are also offering a free education DVD for a limited time. There is a three minute trailer available and it looks to be
a very interesting and informative show.
Thanks for keeping us abreast of EVERYTHING going on in the world
of LTC! One of your biggest
fans . . . Amy L. Locke, CLU, CLTC, www.LTCdesigns.com
***
#############################
LTC BULLET: ON
ASSET TRANSFERS, CHARITABLE GIVING AND NURSING HOMES
LTC Comment: Let's
set aside for now the irresponsible, demagogic, politically biased media
attacks by big, self-righteous, publicly financed lobby groups who defend
the corrupt status quo in long-term care financing for the benefit of
their affluent members. Gee,
who could that be?
Some very thoughtful, concerned, and respectable
people have also expressed doubts about certain provisions in the deficit
reduction bill. They wonder
whether longer and stronger Medicaid transfer of assets restrictions will
discourage charitable giving and leave nursing homes with more residents
who are both ineligible for Medicaid and unable to pay for their own care.
#############################
Following are two examples and our replies allaying
their concerns.
This note came from Greg Pierce, Director of
Development, Mennonite Home Communities of Lancaster, PA.
We reprint Mr. Pierce's email with permission.
To the editor of LTC Bullets:
I would be very pleased to hear your response to the implications
that any charitable gifts given (my church, other 501c3s, etc.) could
disqualify people from Medical Assistance under the new bill.
I agree that gifts to family members need to be controlled, but
let's not disqualify those of us who tithe and generously support various
charities. Isn't there a
difference? This might be a
big enough issue to warrant addressing in one of your e-grams.
Greg Pierce
We replied to Mr. Pierce as follows:
Dear Greg:
Thanks for the feedback.
Point one is that under current and proposed federal
law, the only asset transfers that can be penalized by delaying Medicaid
eligibility are those that are done for the purpose of qualifying for
Medicaid. So, an
appropriately documented or proven transfer to your church for any other
reason would not cause a penalty.
Keep in mind, however, that when people impoverish
themselves by donating to your church or giving money away to anyone else
for any reason, they become vulnerable to Medicaid's dismal reputation for
problems of long-term care access, quality, reimbursement, discrimination
and institutional bias. That
is not a consummation that caring people would wish on anyone in exchange
for a donation. The only way
to improve Medicaid is to preserve it for the poor and encourage private
financing alternatives that come from responsible planning, saving,
investing and insuring for everyone else.
Nevertheless, here's another point of ethics that is
critical. When people make
donations to charities, it should be with money that belongs to them and
that they can afford to give away. When
they make donations and then expect the government to pay for their
long-term care, they in effect are transferring the cost of their
donations to taxpayers. Most
taxpayers have their own preferred charities and would rather donate to
them than to someone else's. The
problem is especially annoying for those of us who pay the premiums for
our parents' and for our own long-term care insurance policies so they and
we will never have to rely on public welfare for our long-term care.
Why should we bear as taxpayers the burden of others' failure to
prepare financially for long-term care?
In the long run, you and your church will be better
off when the government targets Medicaid to the genuinely needy and
encourages those who are financially able to purchase insurance or utilize
their home equity. People who
are thus truly secure financially will be in a much better position to
donate even more generously to their own preferred charities.
Best regards,
Steve Moses
#############################
The second well-considered comment we want to
highlight on the likely impact of the deficit reduction bill came from
Harley Gordon, President of the Corporation for Long-Term Care
Certification, a company that trains and certifies long-term care
insurance agents. In a widely re-circulated communication to his members, Mr.
Gordon analyzed the likely winners and losers if and when the deficit
reduction bill becomes law. He
concluded that in most respects nursing homes would be losers in that they
would have more residents who end up with no source of payment for their
care. We responded thus:
Dear Harley:
I agree with most of your analysis.
Regarding the effect of the new law (should it pass) on nursing
homes, however, I respectfully disagree.
You seem to assume that people will go on
transferring assets as before even after the reasons to do so have been
eliminated. That's highly
unlikely. This law will send
the message that half-a-loaf and three-year-back transfers are no longer
smart planning. Attorneys and
other advisors will therefore no longer recommend them.
To do so, they'd be inviting malpractice suits.
Consequently, more people will pay privately for all
levels of LTC, including nursing homes.
Nursing homes will have more private payers and no more no-payers.
Stronger hardship provisions and the fact that eligibility
penalties do not apply to transfers done for reasons other than to qualify
for Medicaid will ensure that. Anyway,
that's my take.
Happy New Year and best regards,
Steve Moses
Harley responded correctly that some people will
still make gifts that could create eligibility penalty problems for them
and I replied:
You and I and others who "get it" are well
positioned to write, speak and educate that aging people should keep their
money and not give it away, unless and until they have LTCi against their
biggest financial risk, at which point they can HONORABLY use
discretionary funds for any purpose.
We have our work cut out for us if the bill becomes law.
But this is a chance to make a lasting contribution to this
country's future well-being. Let's
do it!
#############################
Updated:
Monday, January 9, 2006, 10:26 AM, (Pacific)
Dateline:
Seattle, WA
#############################
CHASING LTC RAINBOWS
LTC
Comment: Linda Koco of National
Underwriter magazine wrote a perfectly OK column in this month's LTC
E-Wire. Except for one
crucial point. Check out
"Editorial Comment: Will
This Be The Year?" at http://www.nationalunderwriter.com/LTC/articles/2006_01_editorial.asp.
She hangs high hopes on the likelihood that LTC Partnerships and a
new kind of annuity/LTCi product may get a boost from Congress this year.
She concludes: "In
short, this could be a good time to get in and expand one’s LTC
business, not escape from it."
Maybe,
but not unless one other critical piece in the LTCi marketing puzzle is
added. Here's how I explained
the missing link in an email to Editor Koco this morning:
Dear
Linda:
LTC Partnerships and linking LTCi and annuities are
promising developments, but they pale in significance compared to a much
more important change that your article ignored.
Low LTCi market penetration even in the four existing Partnership
states is caused by generous availability of Medicaid- and
Medicare-financed nursing home and home care.
The existing Partnerships and LTC policies have made little
progress in the financial marketplace.
What should make us think that nationalized Partnerships and new
kinds of LTCi policies will make a difference?
They won't unless Medicaid stops giving away what the LTCi industry
is trying to sell--to exactly the same demographic that should be buying
the private insurance.
If the Deficit Reduction bill becomes law as
currently constituted, with significant new controls on Medicaid
eligibility and Medicaid planning abuse, more people will buy LTCi.
If Medicaid is left as is, expanding the Partnerships and adding
new kinds of LTCi policies will have little effect. That's the lesson LTC insurers have refused to learn.
And it's the main reason their companies are unprofitable, their
producers are struggling, and the aging Americans they should be
protecting with quality private insurance are dying in nursing homes on
welfare instead.
Steve Moses
#############################
ON A PERSONAL NOTE:
This weekend, I visited yet another relative who purchased
long-term care insurance years ago at my recommendation and is now about
to collect on that investment. (I
have never sold a policy nor received a referral fee for a policy sold to
a friend or relative.) My
aunt is in a nursing home that costs $192 per day.
Medicare and her Med-Supp policy are covering the whole period of
her LTCi deductible. If and
when she is able physically to transfer to a more commodious assisted
living facility nearby, her private LTCi policy will pay.
Medicaid would not have paid. Without her LTCi policy, she'd have been stuck in the largely
Medicaid-financed nursing home where she resides now. (Nearly all nursing homes are largely Medicaid financed;
Medicaid covers two thirds of all nursing home residents.) The staff at the nursing home are so overwhelmed they simply
do not have time to encourage my aunt to do her physical therapy and
exercises. The food is barely
edible. Without the private
insurance, she'd have had to endure those conditions or pay through the
nose for a more desirable setting.
Of the dozen or so friends and relatives who I know
took my advice and purchased LTCi over the years, three have already
benefited from that decision. Two
of them received benefits for several years.
The rest, including myself, my wife, and thankfully my parents (93
and 91), remain independent, knock on wood.
But we're protected. We
are part of the solution, not part of the problem.
And proud of it!
Steve Moses
#############################
Updated:
Friday, January 6, 2006, 9:56 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC
Bullet: Index of the
Long-Term Care Uninsured
LTC Comment: Who's
insured for long-term care and who isn't?
After the ***news.***
#############################
*** RECENT NEWS STORIES HELP MAKE THIS BULLET'S POINT
Kaiser Daily Health Policy Report Highlights News
Coverage of Recent Developments in Medicaid, Other State Health Insurance
Programs Access this story and related links online: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=34537
New York: The
New York Times on Dec. 23, 2005, examined how a number of counties in
New York state have "been driven to financial desperation by the
rapidly rising cost of Medicaid."
New York is the only state that requires local governments to pay a
large share of Medicaid costs. In
recent years, "the Medicaid rolls upstate and around New York [City]
have swelled sharply, as the state expanded eligibility and the number of
jobs offering health insurance shrank," the Times reports.
The problem "is most serious in counties upstate, which lack a
broad tax base but have a growing Medicaid population," the Times
reports. Counties have taken
a number of steps to counter the financial problems caused by Medicaid,
including raising taxes, reducing services and laying off workers
(Perez-Pena/Luo, New York Times, 12/23/05).
Kaiser Daily Health Policy Report Highlights Recent
Opinion Pieces on Health Care Issues Access this story and related links
online: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=34539
Robert Samuelson, Washington Post:
As baby boomers reach retirement age, "their huge federal
retirement benefits may seriously damage the economy and American
politics," Samuelson writes in a Post opinion piece.
According to Samuelson, if Social Security, Medicare and Medicaid
are "left alone," they "would require massive tax
increases, cause immense deficits or crowd out other important government
programs" (Samuelson, Washington Post, 12/28/05). ***
#############################
LTC BULLET: INDEX
OF THE LONG-TERM CARE UNINSURED
LTC Comment: Our
thanks to Eileen Tell of the Long-Term Care Group, Inc. for another in her
series of "Reality Check" LTC Bullets. It follows after this brief clarification and comment.
The Index described in the following article measures
market penetration of PRIVATE long-term care insurance, which as you'll
see is very low. A far more
important factor is that most people are covered already by PUBLIC
long-term care insurance, i.e. Medicaid.
The Index of the Long-Term Care Uninsured excludes
people with incomes below $20,000 per year because they would be eligible
for Medicaid and inappropriate for private LTCi with its relatively high
premiums.
Critical to understand, however, is that Medicaid LTC
benefits are available to nearly everyone, regardless of income or assets,
without spending down their savings for care first. Medicaid has no limit on income if an applicant's medical
expenses, including nursing home care, are high enough.
The program has no limit on assets held in exempt form, such as a
home, business, car, home furnishings, term life insurance benefits, etc.
Of course, with only a three-year asset transfer look back, anyone
who plans ahead can get Medicaid for LTC no matter how much they give
away. The affluent can hire
Medicaid planners to hide additional income and assets.
The critical take-away from all this is:
"No wonder so few people buy LTCi.
The government has been giving it away for 40 years."
Never mind that Medicaid has a terrible reputation for problems of
access, quality, reimbursement, discrimination, institutional bias, and
loss of independence and control. Nobody
thinks about those drawbacks until it's too late for private insurance and
the path of least resistance is to qualify for public benefits.
Help is on the way, however. If the House of Representatives re-passes the Senate's
slightly modified version of the Deficit Reduction bill, we'll make a huge
step forward to give Medicaid back to the poor and incentivize others to
buy LTC insurance or use home equity for long-term care.
Unless or until that happens, the Index of the Long-Term Care
Uninsured will remain in the dumps.
#############################
"Index of the Long-Term Care Uninsured"
by
Eileen Tell
We have all heard the familiar refrain that there is
tremendous untapped market potential for private insurance financing of
long term care needs. However,
estimates of market penetration vary, given differences in what and how
penetration is measured.
In 2003, the Long Term Care Financing Strategy Group
of Washington D.C. developed a method to estimate an Index of the Long
Term Care Uninsured. This
index tracks trends in the population without financial protection against
the devastation of long term care needs.
Specifically the Index focuses on adults ages 45 and older with
incomes such that they could theoretically afford long term care insurance
(i.e., those with incomes of $20,000 or more) who would not immediately
qualify for Medicaid coverage.
This year, the Index was compiled using Census data
and information on long term care insurance policies in force as of
December 2004 from LIMRA, a market research trade group.
The state distribution of policies in force is based on information
from the National Association of Insurance Commissioners, the Federal Long
Term Care Insurance Program and the California Public Employees Retirement
System (CalPERS) Long Term Care Program.
The Index is based on a concept developed by John A.
Cutler, J.D., a long term care policy expert currently at the U.S.
Administration on Aging, with research analysis originally conducted by
Marc Cohen, Ph.D., President, LifePlans Inc.
John Cutler and Marc Cohen, along with Malcolm Cheung of Prudential
and Eileen J. Tell of Long Term Care Group, Inc., created this third
annual report.
On a national basis, the Index of Long Term Care
Uninsured shows that:
Approximately 95 percent of persons between the ages
of 45 and 64 (with incomes over $20,000) are uninsured for long term care.
This figure is essentially unchanged from the 2003 levels.
For those ages 65 and over, 85 percent are uninsured
for long term care, compared with the 2003 figure of 82 percent.
This slight increase may reflect the fact that the average age of
purchase for long term care insurance is declining.
Given the recent decline in policy sales, along with
the rate of growth among the eligible population, it comes as no surprise
that, over the last two years, the percent of the population that is
uninsured for long term care nationally has increased slightly. While policy sales to younger buyers are increasing as a
percent of the total, policy sales overall are down.
This, coupled with the fact that boomers are one of the fastest
growing population segments is one of several reasons why there has not
been any significant change in market penetration since 2003.
This
year, for the first time, the Index of the Long Term Care Uninsured also
looked at state-specific trends, identifying the proportion of older
adults who are uninsured for long term care within each state. Like the national Index, the state-specific analysis focuses
on the adult population age 45 and older with incomes of $20,000 or more.
We find tremendous variations across states, including some of the
following:
The
percent of older adults who are uninsured for long term care ranges from a
low of 78% to a high of 97% across the 50 states and the District of
Columbia;
Eighteen
states have a market penetration of long term care insurance that is above
the national average. They
are, in decreasing order of market penetration for long term care
insurance: North Dakota,
Nebraska, South Dakota, Iowa, Texas, District of Columbia, Virginia,
Maine, Kansas, Missouri, Minnesota, Florida, California, Wisconsin,
Connecticut, Colorado, New York and Illinois.
State
Initiatives and Incentives
We
are only beginning to understand how the many diverse factors in these
states influence these trends. The
variables at work across the states with the highest and lowest market
penetration are complex. First,
there are differences in terms of the size, education, age distribution
and income among older adults across various states.
Also, some states have adopted one or more of several specific
initiatives to reduce reliance on Medicaid by encouraging and enabling
more adults to obtain long term care insurance.
While
we have only begun to try to isolate and understand all these factors, a
very preliminary analysis suggests that raising awareness and providing
incentives to promote the purchase of long term care insurance likely have
some effect on reducing the rate of “uninsurance” for long term care.
There are many actions a state can undertake to encourage private
responsibility for long term care planning.
State tax incentives, a public-private Partnership initiative,
public education and awareness, a long term care insurance program for
public employees and retirees, speed to market activities and others are
among those states ought to consider.
In
analyzing the variations found in the state component of this third annual
Index of the Long Term Care Uninsured, we do see greater market
penetration in states that have adopted tax incentives for long term care,
with a tax credit having a greater impact than a tax deduction, but both
being important. Specifically,
market penetration among states with a tax credit or deduction for long
term care is 8.1% compared with 6.7% in states without such incentives.
Similarly,
in states with a state-sponsored long term care insurance program for
public employees and retirees, market penetration is 8.1% compared with
4.6% in states without such a program.
Also,
of the 18 states that have “above average” market penetration for long
term care insurance, three of them (California, Connecticut and New York)
have the “Partnership for Long Term Care” Program, a model being
considered for national expansion which combines Medicaid and private long
term care insurance.
“Own
Your Future” – Long Term Care Consumer Awareness Campaign
We know that awareness is a critical element in any
strategy designed to increase market penetration.
Too many people learn about long term care the hard way – when
they and their loved ones need care.
That’s often when they become aware of the harsh realities of
paying for care. Many people
don’t think about their future long term care needs and therefore fail
to plan appropriately. If
individuals and families were more aware of their potential need and the
options for addressing it, they would be more likely to take steps to
prepare for the future.
These
are the critical premises behind the Department of Health and Human
Services’ (HHS) Long Term Care Consumer Awareness Initiative called
“Own Your Future.” The
Campaign represents a unique partnership between the federal government
and the states to offer a consistent, and long overdue, message about
personal responsibility and planning ahead for long term care needs.
Another key element of the Campaign and, one which has been vital
to consumer acceptance, seems to be the objective sponsorship –
providing education and awareness from an independent government source.
Phase
I of this awareness demonstration project was launched in January 2005 in
Arkansas, Idaho, Nevada, New Jersey and Virginia. Governors from those states each sent letters to over two
million households with consumers ages 50 to 70 encouraging them to plan
for their long term care needs and offering a Long Term Care Planning Kit
which provided basic information on how to plan for a broad range of long
term care issues including private finance.
The
response rate to the direct mail and media campaign was about 8% across
these states. Individuals
from all demographic segments within the target market found relevance in
the campaign. Industry
representatives have indicated that they have seen a favorable impact on
awareness, inquiries and in some cases sales of private long term care
insurance in the campaign states.
A survey of consumer attitudes and behavior among those targeted in
the Awareness Campaign is nearing completion.
Preliminary analysis suggests that consumers who ordered the Long
Term Care Planning Kit were more likely to review their existing coverage
to see if it provided for long term care needs, consult an agent or
financial planner about long term care insurance, or buy long term care
insurance following the January 2005 launch date of phase I of the
campaign in these states. (More information about the campaign is
available at both www.ltcaware.info
and http://www.aoa.gov/ownyourfuture/index.asp
)
The
Awareness Campaign is an important model and a great start.
But it will be important for states and the federal government to
continue and expand on all of these efforts to make consumer more aware
and motivate them to plan ahead for their future long term care needs.
Eileen
Tell is Senior Vice President of The Long-Term Care Group, Inc.
She has written a series of "Reality Check" LTC Bullets.
Notes:
The Index excludes those with incomes under $20,000 which necessarily
includes those individuals on Medicaid.
This is a generally accepted absolute minimum threshold for
suitability, though it should be noted that $35,000 is used by the
National Association of Insurance Commissioners as a suggested income
criterion for purchase. For
more information about the Third Annual Index, go to http://www.ltcg.com/LTC%20financing%20strategy%20group.htm
For the full report, go to http://www.ltcg.com/INDEX%20of%20Long%20Term%20Care.pdf.
The Long Term Care Financing Strategy Group is a non-profit,
non-partisan think tank comprised of academics, researchers, policy
analysts, and individuals representing aging organizations, providers,
insurers and others. It
brings together public and private perspectives, and provides a forum to
address long term care financing issues and offer solutions.
#############################
Updated:
Thursday, January 5, 2006, 10:14 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC DATA UPDATE
LTC Comment: Following
are some sources of LTC-related data we hope you will find useful.
In a nutshell: whether
you are a provider or insurer of long-term care--know your prospects; know
what LTC will look like in the future; and know why people will need to be
able to pay privately for it.
#############################
KNOW YOUR PROSPECTS:
"The Pew Research Center in Washington, D.C., recently
released its findings from the first in a planned series of surveys on
social trends in the United States. Titled
'Baby Boomers Approach Age 60: From
the Age of Aquarius to the Age of Responsibility,' the report shows that
many boomers are balancing a full plate of family financial
responsibilities as they approach retirement.
According to the report, 'in the past year, 50 percent of all
boomers were raising one or more young children and/or providing primary
financial support to one or more adult children, while another 17 percent
whose only children are ages 18 and older were providing some financial
assistance to at least one such child.'
In addition, the study found that two in 10 boomers provide some
financial assistance to a parent -- and that one in eight boomers is
sandwiched between supporting a parent and a child.
For more information on the study and for a free PDF of the 44-page
report, visit http://pewresearch.org/socialtrends."
PBS DOCUMENTARY TO FOCUS ON CULTURE CHANGE IN
LONG-TERM CARE: "'Almost
Home' is a new PBS documentary chronicling a year in the life of a vibrant
retirement community implementing culture change, an innovative approach
to the challenge of making a nursing home actually feel like home.
Focusing on the memorable experiences of residents, their families
and those who care for them, the program gives viewers a personal look
into a subject of importance to everyone who cares about aging.
The national PBS broadcast of 'Almost Home' is set for the evening
of Jan. 31, 2006 (check local listings for times). Complementary resources
are available at http://www.almosthomedoc.org.
The site features discussion guides and film clips, as well as
links to public television stations and national partners organizing
community initiatives around the film. In addition, a DVD of the film with extra educational clips
and a trailer is available free until the broadcast date; for details,
contact Lauren Burke at laburke@uwm.edu."
Source:
Preceding two items are from "ASA Connection," January
2006, an e-mail newsletter providing updates on events in aging, research
and policy developments, innovative practices and more, distributed
monthly to members of the American Society on Aging and other
professionals in the field of aging.
Current and past issues are available with additional links and
expanded content on the ASA website at http://www.asaging.org/asaconnection.
#############################
ALMOST HALF OF FEDERAL DOLLARS GO TO ENTITLEMENT
PROGRAMS, Census Bureau Report Says.
Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=34532.
More than $1 trillion of the $2.2 trillion in federal spending
during fiscal year 2004 went to Medicare, Medicaid and Social Security,
according to the Consolidated Federal Funds Report released on Dec. 27,
2005, by the Census Bureau, the AP/Indianapolis Star reports.
Overall, federal spending in 2004 increased 5% over spending levels
in 2003. According to Gerard Keffer, chief of the Census Bureau's
federal programs branch, the federal spending increase had been running
between 6% and 8% in recent years. Rudolph
Penner, a senior fellow at the Urban Institute and former director of the
Congressional Budget Office, said the aging population and increasing cost
of health care will lead to higher entitlement spending in the future.
Penner said, "I think [entitlement programs] are going to
squeeze out all sorts of other spending items," adding, "I think
it's absolutely essential and inevitable that we are going to reform those
programs" (Ohlemacher, AP/Indianapolis Star, 12/27/05).
WASHINGTON TIMES LOOKS AT GROWING SENIOR POPULATION'S
EFFECTS ON HEALTH SYSTEM. Access
this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=34535.
The Washington Times on Friday in the last installment of a
five-part series on baby boomers examined how the "burgeoning senior
population" will "shock" the U.S. health care system in
future years. The senior
population is expected to double from 35 million to 70 million over the
next 20 years, in part because the health of seniors older than 65 has
been improving since the 1980s. While
"some financial savings could be realized if the trend" of
improving senior health continues, costly new medical technologies could
offset those savings and "greatly increase Medicare costs,"
according to RAND, the Times reports.
In addition, the National Institute on Aging and the American
Association of Homes and Services for the Aging predict that elder care
will shift from nursing homes toward more support-based services and
technology that allow in-home monitoring of medical conditions.
As a result, changes to Medicare and Medicaid reimbursement
schedules will be needed to pay for such services, according to Russell
Bodoff, executive director of the Center for Aging Services Technologies
(Howard Price, Washington Times, 12/30/05).
Source: Preceding
two items are from Kaiser Daily Health Policy Report, Tuesday, January 3,
2006.
#############################
Updated:
Wednesday, January 4, 2006, 11:45 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC
Bullet: NPR Defends Medicaid
Planning, Attacks Messenger
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, after the
***news.***
*** Check out Phyllis Shelton's new FREE newsletter,
"The LTCI Harvest." It is her latest effort to spur LTCI
sales. You can subscribe
simply by going to www.ltciharvest.com
and entering your email address in the upper right-hand corner.
Kudos to Phyllis for another job well done. ***
***
Our thanks to Liz Shilling's AHCA / NCAL Gazette on Wednesday,
12/28/05 for providing these summaries and links to two important stories.
They underscore the point of today's LTC Bullet that entitlements
like Medicaid are out of control and private long-term care insurance is
an important part of the solution.
"Entitlements
Consume More Federal Spending. By
the Associated Press. The
New York Times. Dec 28, 2005. Social
Security, Medicare and Medicaid consumed more than $1 trillion in federal
spending in budget year 2004, according to a report being released today
by the Census Bureau. Medicare
spending is expected to increase with the new Part D benefit that kicks in
on Sunday. http://www.nytimes.com/aponline/national/AP-Federal-Spending.html?pagewanted=print"
"Insurers
push policies for long-term care. By
Jeff D. Opdyke, The Wall Street Journal. Pittsburgh Post-Gazette.
Dec 27, 2005. In the wake of Congressional action to tighten rules
governing eligibility for Medicaid-financed long term care, insurance
companies are trotting out new policies that offer a range of added
features. One company is
offering a product that combines long-term care insurance with an annuity
that is paid out if the long-term care portion is never used.
Another company will offer low-cost short-term policies and a
'shared care' policy. Other
insurance companies are aggressively marketing long-term care insurance
packages to employers for their workers.
New tax shelters could provide encouragement for people to purchase
long-term care insurance policies. http://www.post-gazette.com/pg/05361/628539.stm"
***
#############################
LTC BULLET: NPR
DEFENDS MEDICAID PLANNING, ATTACKS MESSENGER
LTC Comment: When
you're an under-funded, one-man "think tank" fighting the
entrenched, richly-foundation-and-government-financed bastions of the
status quo, you get used to having "the truth you've spoken twisted
by knaves to make a trap for fools," as Kipling put it.
But this takes the cake.
Yesterday, NPR's popular "All Things
Considered" drive-time talk show tackled a topic close to our
hearts. A blurb from public
radio's website describing the five-and-a-half minute segment follows.
Listen to the whole story online at http://www.npr.org/templates/story/story.php?storyId=5081528.
"Congress
to Enact Tighter Medicaid Restrictions by Joseph Shapiro.
All Things Considered, January 3, 2006.
Congress is preparing to place stricter limits on who can qualify
for Medicaid. It's an effort to lower the program's exploding costs for
nursing home care. One
target: wealthy people who
give away assets in order to qualify for Medicaid help for nursing home
care. The problem is, there's no evidence that people do this, and
some analysts believe the new restrictions could place new burdens on the
very people the program seeks to help -- the poor."
Summary
of the Show:
Introduction:
"It sounds outrageous, millionaires on Medicaid, the rich
covered by the health insurance program that is supposed to be for the
country's poorest people. Well
that is the claim and it holds so much sway in Washington that Congress is
about to make it harder for the wealthy, and for just about anyone to get
Medicaid nursing home coverage. As
NPR's Joseph Shapiro reports, that could mean new burdens for the people
the program is designed to help, the poor."
At
once snarly toward interviewee Steve Moses and smarmy toward the audience,
reporter Joe Shapiro first builds up, then knocks down a public policy
straw man. He uses techniques
of argument recognized as fallacious sophistry centuries ago.
First
he quotes Moses to the effect that it is easy for millionaires to qualify
for Medicaid, which is true, but that the bigger problem is that most
people are routinely eligible for Medicaid's LTC benefits without spending
down, which is also true.
Then,
however, reporter Shapiro claims there is "no hard and fast
evidence" for these facts. He
ignores the plethora of articles and reports to which we referred him on
the Center's website at www.centerltc.com
for evidence and documentation. Instead,
he tries to impugn our integrity.
He
says a quote we cited about "Medicaid for Millionaires" on the
website of a trainer of Medicaid planners wasn't there.
But then he admits that the quote had been there when we cited it
but that the Medicaid planner removed it because of the "havoc"
the quote caused. Our
critical coverage of many Medicaid planners' irresponsible advertising
often causes them to tone down their rhetoric.
Unfortunately, they usually continue to practice their abusive
artificial impoverishment techniques "under the radar."
For
proof, read our original expose' of that Medicaid planning trainer in
"LTC Bullet: What
Should Be Done About Medicaid Profiteers?" published December 3, 2003
at http://www.centerltc.com/bullets/archives2003/473.htm.
Then, check out the current, white-washed version of his
promotional brochure at http://www.medicaidpractice.com/docs/brochure.pdf.
You'll see that he still offers a 6-day training program for $7,495
that "will show you how to establish
your new Medicaid Practice profit center and generate $100,000+ in the
next six months." That's
pretty lucrative compensation for a business about which NPR claims there
is no "hard and fast evidence."
When
our quotes and documentation proved his first snide intimations untrue,
reporter Shapiro turned to another underhanded approach--the ad hominem
attack. He says that people
"like Moses" who oppose abusive Medicaid planning are often just
promoting private long-term care insurance.
He points out that the Center "is paid in part by the
insurance industry." What
a hoot!
Our
tiny Center for Long-Term Care Reform barely survives on a patchwork of
small contributions, membership fees, consulting, speaking and expert
witness work. Contrast that
with the millions of dollars from foundations and tax payers that
lucratively finance defenders of the corrupt status quo like AARP, the
National Academy of Elder Law Attorneys (NAELA), the Georgetown Long-Term
Care Financing Project, and yes, National Public Radio, among many, many
others.
Compare
the easy money Medicaid planners make artificially impoverishing affluent
clients with the relative pittance long-term care insurance agents
receive. We call those
struggling agents "AMGs" because it takes an altruistic,
masochistic genius to sell the public private insurance protection against
a risk the government, with the help of Medicaid planners, has given away
for forty years to nearly everyone. The
Center for Long-Term Care Reform advocates for private LTC insurance as
the best way to save Medicaid for the truly needy, that is, as a means,
not an end in itself.
When
his second devious attack proves ludicrous, reporter Shapiro turns to an
ostensibly reliable source for evidence that Medicaid planning is no big
deal. He cites a recent GAO
study that found Medicaid asset transfers commonplace, but small on
average. This approach leads
nowhere either. See our
"LTC Bullet: GAO on TOA
Underwhelms," published October 5, 2005 at http://www.centerltc.com/bullets/archives2005/581.htm,
which explains how "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."
Check it out to see why GAO has little credibility on this subject.
Finally,
NPR tries to make the case that Medicaid reform--already passed by both
Houses of Congress and impeded from becoming law by a technicality--would
hurt the "poor and middle class."
To establish that dubious proposition, they turn to Charles
Sabatino of the American Bar Association's Commission on Law and Aging.
Sabatino is a past president of NAELA, the trade association of the
Medicaid planners themselves! Talk
about the fox guarding the henhouse.
According
to Sabatino, the new legislation designed to target Medicaid to the
genuinely needy and discourage Medicaid planning abuses, would actually
"scoop" up all asset transfers made by poor and middle class
people and use them to keep such deserving folks from getting help from
government for their long-term care.
We have two points to make in response, which of course did not
find their way into the NPR slantcast.
First,
why should Medicaid and tax payers indemnify people for careless and
unwise donations to charities or give aways to their children or gifts to
their grandchildren? Aging
people should anticipate the high probability of needing expensive
long-term care and save, invest or insure against that risk.
If they choose to give their wealth away instead, however noble the
purpose, that's fine but public policy should not reward such failure to
plan responsibly with a windfall from the welfare program.
Second,
the idea that the new legislation will penalize the poor and middle class
for all kinds of transfers for any possible reason is simply wrong.
Current law is strengthened by the new legislation in its explicit
application of asset transfer penalties only to assets transferred for
less than fair market value for the purpose of qualifying for Medicaid.
Hardship waivers also apply to protect genuine victims of
commonplace financial abuse of the elderly.
NPR's
attempted hatchet job is likely to have exactly the opposite of its
intended effect. Rational
people will see through such biased reporting to the underlying truths.
Medicaid spending is out of control.
Congress and the President are doing something about it.
Long-term care insurance is the best option for everyone who can
qualify for it medically and financially.
Home equity conversion is the next best choice to finance the
red-carpet access to top quality care that private payers are guaranteed.
And Medicaid could and should provide more and better care to the
poor, if it no longer has to line the pockets of avaricious lawyers,
greedy heirs, and self-serving policy wonks.
In
the meantime, we'll take some more advice from Kipling's poem
"If," to "keep your head when all about you are
losing theirs and blaming it on you," to "trust yourself when
all men doubt you," and to "fill the unforgiving minute with
sixty seconds' worth of distance run."
So, I'm off to the gym for thirty minutes on the
treadmill.
Steve Moses
#############################
Updated:
Tuesday, January 3, 2006, 10:39 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC CORRESPONDENCE
LTC Comment: Let's
celebrate the start of a new year with a few items of correspondence we
received and/or responded to since going offline ten days ago.
But first, during that time there has been a flurry
of activity related to the Deficit Reduction Act.
Passed by both Houses in the waning hours of the first session of
the 109th Congress, the bill could not go to the President for
signature until it is re-passed by the House of Representatives in a form
identical to the version passed by the Senate.
AARP and the Medicaid planners are mobilizing their
troops to derail the legislation, which includes LTC Partnerships and
Medicaid eligibility reform. Our
side--the good guys--are getting the word out that this critical LTC
legislation is not a done deal and that the fight must go on.
So call and write your Representatives.
Ask them to support this important legislation.
We'll have more on this political thrill ride as
developments warrant. But we
probably won't know the outcome until after the House of Representatives
gets back to work in February.
#############################
In the meantime, here's an example of the kind of
correspondence we receive frequently from people on the other side of the
Medicaid reform issue. This
email came from a Medicaid planning attorney in response to our LTC Bullet
which explained the status of the Deficit Reduction Act, as summarized
above.
INCOMING: "Gimme
a break....my clients aren't millionaires, and they deserve to keep their
money just the same as the rich who use accountants to use the tax laws to
avoid paying their share. America's black eye is the lack of free medical treatment and
nursing homes. Have you
bothered to mention the $70 billion tax breaks that are being given to the
wealthy? Not to mention the
$220 million/day we waste in Iraq?"
MY REPLY: "Thanks
for the feedback. My focus is
long-term care. I'll leave
tax and foreign policy to others. For
LTC, however, we have a failed system that serves no one well.
Alas, free care for everyone is not free for anyone.
We pay for it in taxes and poor quality.
European social insurance systems will collapse before our
welfare-based system does and our mess is easier to fix than theirs.
But the only way to fix it is to give Medicaid back to the poor and
divert everyone else to savings, home equity, or insurance.
Richly rewarding attorneys and accountants for diverting Medicaid's
scarce resources to affluent clients benefits no one except the elder law
bar. That's the way I see it
and I've nailed the evidence and logic in numerous reports and
publications as you'll see if you dig deeper at www.centerltc.com.
I'm always open to civil discussion of these issues, but I've yet
to find a Medicaid planner who can defend the practice ethically.
Regards, Steve"
#############################
Here's
a note that warmed my heart from Law Professor and elder law expert
Richard Kaplan of the University of Illinois:
"Dear
Steve, I have been a
subscriber/contributor in the past in large part because of philosophical
compatibility, but the Bullets this past week have underscored the
professional necessity of receiving your extremely current and dependably
accurate analyses. These
behind-the-scenes play-by-play reports are simply invaluable for anyone
who wants to know the lay of the land regardless of political preferences
or policy orientation. I have
been impressed beyond my already-high expectations.
Bravissimo! As they
say on Capitol Hill these days, 'Merry Fristmas.' -- Dick"
In
a follow up note responding to my request to quote him, Dick clarified as
follows:
"In
a 2004 Illinois Law Review article, I set forth why I think that
nursing home costs should most properly be covered by Medicare, but I
never harbored any fantasies that such an approach was politically doable
any time soon, especially after the expansion of Medicare to cover
prescription drugs. I also
believe that there are some significant problems with private long-term
care insurance [which I have of course], as my article set forth in some
detail. Nevertheless, the idea that Medicaid should be what folks
PLAN to access is absurd and counterproductive for all the reasons that
you have so eloquently delineated over the years."
Kind and thoughtful comments eloquently articulated
and much appreciated.
#############################
Finally,
a note from a good friend, long-time Center supporter, and A-Number-One
long-term care producer, Honey Leveen of Houston, TX:
"Happy
New Year, Steve!
"2006
is going to be an unbelievable year for sales of LTCi, in my opinion.
This is due in no small part, to your efforts.
"I
now have people calling in already knowing they need to buy LTCi, just
needing my help shepherding them through the learning, evaluation and
application process. This is
very different than in the past, when I had to convince them they needed
LTCi, and I had to convince them not to put off their decision.
"I
have more people eager to speak with me and almost doting on every word I
say, people returning my calls very fast and not avoiding me, people
already knowing they must buy LTC, people treating me as if I am their
doctor and coveting our relationship, due to the change in peoples
awareness of LTC issues. Many
have already spent time reading my website and qualifications in detail
before they call me--this didn't happen a year or so ago.
I have clients now calling who have already spent considerable time
researching LTC before they call me.
In the past I had to school them on everything.
Over all, this past year I noticed a difference in clients'
eagerness and enthusiasm to discuss and purchase LTCi.
"I
am sure that these changes in the public's increased perception of the
seriousness of the LTC crisis are largely or partly due to The Center for
Long-Term Care Reform's efforts. I
believe the CLTCR's constant vigilance and quest to get the truth in front
of the public, must have played a significant role in this change of
public awareness.
"HSL"
#############################
Thank
you, Honey, and thanks to all our wonderful supporters who have helped to
bring important changes in LTC public policy to the brink of success.
Whether or not we win the current battle, it is clear that public
opinion about the need for private LTC financing has changed permanently
for the better.
We
ARE winning. STAY the course!
Steve
Moses
#############################
Updated:
Friday, December 23, 2005, 11:34 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC
Bullet: Season's Greetings
and then Some
LTC Comment: We
usually close each year with one LTC Bullet to summarize what we've
accomplished on your behalf in the preceding 12 months and a second Bullet
to wish you Merry Christmas, Happy Hanukkah, a Joyous New Year and
all-around Season's Greetings.
Then
we say farewell 'til next year: Great
progress lies ahead if we persevere in the fight for rational and fiscally
sound LTC public policy reform. So
let's rest, relax, refresh and rejoin the battle reinvigorated.
"LTC Bullets" and our daily "LTC E-Alerts" for
members will resume in January.
This year's a little different, however.
It comes to a close in a flurry of Congressional activity.
We came a hairsbreadth away from achieving two of the Center's most
hard-fought goals, to wit, Medicaid eligibility reform and stronger
incentives for private LTC financing alternatives.
But as they say in soccer, "right beside the goal is no
goal."
So this year, much is left hanging.
We're on the verge of a major public policy success, but forces are
mobilizing to prevent positive reform.
More than ever, we need your help to keep the pressure on, to
defend what we've achieved so far, and to finalize it as law signed by the
President early in 2006.
We've set a record in the past week:
seven LTC Bullets in eight days.
If you're thinking "enough already," we couldn't agree
more. So we'll skip this
year's recounting of "What Have You Done for Me Lately," and
simply say "It was a great year with major achievements and enormous
public policy impact far beyond our size, all thanks to your support and
encouragement."
We need your continued support to finish the job.
If you can see your way clear to help the Center for Long-Term Care
Reform with a financial contribution, we'd be much obliged.
Annual individual memberships are $150.
Corporate memberships to bring our publications to everyone in your
organization or company are negotiable.
If you have a budget for subscriptions, our LTC Bullets and
E-Alerts would surely qualify. Maybe
the Center would be a business expense for your tax purposes.
Check with your CPA.
Please
mail your contribution to the Center for Long-Term Care Reform, 2212 Queen
Anne Avenue North, #110, Seattle, WA
98109 or contribute online at http://www.centerltc.com/support/index.htm
. Call or email us anytime at
206-283-7036 or info@centerltc.com.
Thank you for being there for the Center and for our shared
mission: to ensure access to
quality long-term care for all Americans.
The
Center for Long-Term Care Reform wishes you a wonderful holiday season and
a terrific New Year. We look
forward to continuing our work with you on behalf of America's seniors,
their families, and long-term care professionals--all of whom are
struggling in the face of so many challenges.
#############################
Updated:
Thursday, December 22, 2005, 10:45 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC
Bullet: LTC Denouement . . .
for Now
LTC Comment: We
warned "don't count your chickens before they're hatched," and
now, sure enough they'll be incubating for at least another month and a
half. Details after the
***news.***
*** LTC PROVIDER PLEADS FOR PASSAGE.
The following email received by the Center for Long-Term Care
Reform yesterday is published with permission from the sender.
We feel it articulates well what is at stake in the current
legislative fight for rational LTC policy reform.
"As
the executive of a faith-based, not-for-profit continuing care retirement
community, I see way too much inappropriate Medicaid planning going on.
While it's understandable that people want to leave their children
some money or support a favorite charity, that is not the purpose of
Medicaid. My 225-bed skilled
nursing facility is now over 80-percent Medicaid.
We are losing money and the board has asked us to develop a plan to
downsize the nursing home. Access to high quality nursing homes is going to be a huge
challenge in the not-too-distant future as a result of over-reliance on
Medicaid funding. I hope the
bill with the proper language is passed and signed into law.
I've contacted each of the Senators.
Thank you for all your efforts to get this legislature this far.
Sincerely, F. Jay Shetler, President and CEO
Glencroft Retirement Community, Glendale, Arizona ***
LTC BULLET: LTC
DENOUEMENT
LTC Comment: The
Oxford English Dictionary defines denouement as "The unravelling of the complications of a plot, or of a
confused situation or mystery; the final resolution of a play, novel, or
other narrative."
The
story of Medicaid reform that we've presented to you over the past few
days certainly qualifies as a confused situation.
And it's just been resolved UNsatisfactorily, at least for the time
being. Here's the story.
By some miracle late last week, the House/Senate
Conference Committee on the deficit reduction package agreed to authorize
LTC Partnerships and place stringent new controls on Medicaid planning.
Early Monday morning, after a Sunday all-nighter, the
House passed the Conference Committee's agreement in toto and
referred it to the Senate.
Yesterday, the Senate passed the Conference
Committee's agreement but with a few minor "parliamentary"
changes.
So, as of now, we have strong legislation passed in
both houses of Congress that would authorize LTC Partnerships, extend the
Medicaid transfer of assets look back period from three to five years, end
the "half-a-loaf" divestment strategy, stop millionaires from
sheltering their home equity, and restrict numerous other technically
legal, but egregiously unethical Medicaid planning tricks.
Unfortunately, because the bill passed by the Senate
is not identical to the bill passed in the House, this legislation cannot
be sent to the President to be signed into law unless and until the House
of Representatives passes it again, with the slight, substantively almost
meaningless changes made by the Senate.
But, there's the rub.
Members of the House of Representatives are back in their districts
all across the country nestled cozily by their fireplaces, Christmas
trees, and/or Menorahs.
That would not have to be a problem.
They could approve the Senate version of this important legislation
by unanimous vote right from home. It
could go straight to the President and be signed into law before Christmas
or Hanukkah. And that's
exactly what Speaker Denny Hastert asked Minority Leader Nancy Pelosi to
allow in an urgent letter yesterday.
Quoth the Speaker:
Dear
Ms. Pelosi: I am writing to
ask you for unanimous consent to approve the conference report on H.R.
4241, the Deficit Reduction Act of 2005.
As you know, the House approved this measure on December 19, 2005
in a 212-206 vote. Unfortunately,
the Senate has now made minor changes, such as simple reporting
requirements, that send the legislation back before the House.
Our members have already returned home to spend the holidays with
their families. By passing
these changes through unanimous consent, we can avoid unnecessary
disruption in the enactment of important program additions and reforms
contained in this legislation. . . .
I don't think any of us wants to see a situation where some of our
neediest Americans are denied care and help because of politics.
It is Christmas season, and not the time to engage in partisan
squabbles. So I would ask you respectfully, to put politics aside, agree
to unanimous consent of these changes and put the American people first.
Sincerely,
J. Dennis
Hastert, Speaker of the House
Quoth
the Minority Leader:
Bah,
Humbug. Well, not exactly,
here's how she actually responded by press release:
"[W]e
will request a recorded vote where all Members return to Washington to
make clear their values to the American people.
Democrats will work with our allies to fight for a budget that
represents the values and needs of all Americans."
So,
what's the bottom line?
The
important changes to long-term care policy that have been passed by both
houses of Congress cannot become law until they're passed again by the
House in a form identical to the Senate's version.
Minority
Leader Pelosi refuses to allow a unanimous vote from home as requested by
Speaker Hastert.
Neither
Speaker Hastert nor President Bush appears to be willing to call the House
back into session immediately for this vote.
The
House of Representatives will not reconvene in Washington, DC under its
regular schedule until Tuesday, January 31.
That
gives defenders of the status quo like AARP and the Medicaid planners over
a month to mobilize opposition to these critical reforms.
That
process of obstruction has already begun as these quotes from today's news
coverage make clear:
"The House had narrowly
passed the bill, 212 to 206, in a predawn vote on Monday, and now, with a
new vote in the House coming, opponents of the budget bill -- from
organized labor to the powerful seniors lobby AARP -- began gearing up for
another fight."
"A coalition of labor unions
and liberal interest groups immediately swung back into gear, drafting a
list of 18 House Republicans in hopes of persuading eight to change their
vote.
"'Make no mistake -- we're
going to keep on fighting until we permanently derail these reckless
budget and tax cuts,' said Gerald W. McEntee, president of the American
Federation of State, County and Municipal Employees, the union that has
largely bankrolled the fight against the budget measure."
The opposition's strategy is
force consideration of the Administration's budget and tax cut proposals
together so as to derail both by arguing that poor people will be hurt in
order to deliver tax relief to the rich.
Demagogy? Sure, but it
could succeed and derail responsible LTC reform.
We'd ask the opposition to
consider this. Giving
Medicaid back to the poor by curtailing artificial impoverishment and
encouraging private LTC financing alternatives is really a FAIRNESS issue.
Why use scarce public welfare resources to indemnify baby-boomer
heirs of well-to-do seniors? Ironically,
most of the affluent beneficiaries of Medicaid planning abuses are likely
to be Republicans! Democrats
who think the issue through will realize they're cutting off their noses
to spite they faces by obstructing rational LTC policy reform.
Anyway,
for now, everything's been thrown into a cocked hat. It looks like we won't know the final outcome until well into
next year. In the meantime,
keep the faith, enjoy the holidays, and gird your loins for another fight,
coming soon in the New Year.
#############################
Updated:
Wednesday, December 21, 2005, 1:23 PM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC
BULLET: GOOD NEWS, BAD NEWS
LTC Comment: Senate
passes deficit reduction bill including LTC Partnerships and Medicaid
planning controls, BUT it's not a done deal yet!
More after the ***news.***
*** LTCI CONFERENCE.
Last chance to get early registration rates ends Friday for the
Sixth Annual Intercompany Long-Term Care Insurance Conference in Anaheim,
CA from February 26 to March 1, 2006.
Check it out at www.ILTCIconf.org.
The Center for Long-Term Care Reform is a co-sponsor of this
meeting and Center president Steve Moses will attend and present.
Our Administrative Coordinator Damon will attend, conduct
interviews, take pictures and publish in-depth information on the event at
our website. ***
***
TODAY'S WALL STREET JOURNAL contains an article by Sarah Lueck
titled "Stiffer Rules for Nursing-Home Coverage:
Congress Expected to Limit Transfer of Assets to Kids in Bid to Cut
Medicaid Costs" on page D1. You
can read it at http://online.wsj.com/article/SB113512385722127936.html
if you subscribe to the Journal
online. Otherwise, pick up a
hard copy. Here's a quote
about today's Senate vote: "'This
is the Congress saying in no uncertain terms that we can't use Medicaid, a
public welfare program, as the primary insurer for everyone,' says Stephen
Moses, founder of the Center for Long-Term Care Reform, a Seattle group
that promotes revamping the Medicaid rules."
***
*** VOLUMINOUS
CONGRATULATIONS you're sending, although appreciated more than you can
possibly know, are somewhat premature as you'll see from reading this
Bullet. But no matter what
happens with current legislation in the end, long-term care policy will
never be the same. We've put
the big issues on the table where they can no longer be evaded.
Funding for Medicaid and the need for private LTC financing
alternatives will only become bigger and more urgent issues as the
demographic walls close in on America.
So if you consider our work worthwhile, please help the Center
survive financially too. Join
for $150 per year or $12.50 per month or get your company or organization
collectively to join so you don't have to pay personally.
Contact Damon at 206-283-7036 or damon@centerltc.com.
He will Zone You In ASAP. To
negotiate corporate and organizational memberships, contact Steve Moses
directly at 206-283-7036 or smoses@centerltc.com.
When you take the need for constant fundraising off our backs, you
free us up to fight for LTC policy reform that benefits everyone.
Thanks for your support. ***
LTC BULLET: GOOD
NEWS, BAD NEWS
LTC Comment: First,
for those of you who took our advice yesterday to call your Senators and
urge passage of the Deficit Reduction Act, congratulations.
We won . . . sort of.
By the slightest of margins, 51 to 50, with Vice
President Cheney casting the deciding vote, the United States Senate this
morning passed legislation to cut the federal deficit by $39.7 billion,
curtail Medicaid planning abuse, and authorize LTC Partnerships. That's the good news.
This is ALMOST the same legislation we've been
tracking for you that was passed by the House of Representatives early
Monday morning after an all-night session, BUT NOT QUITE.
That's the bad news. Here's
the story.
Green-eyeshaded Senate minority staffers fighting to
kill this crucial legislation discovered that the Conference Agreement
passed by the House contained some arcane procedural nuances that
constituted technical violations of Senate rules.
They prevailed to strip these provisions from the Senate version.
Here's the kicker.
Both houses of Congress must pass the IDENTICAL bill before it can
be sent to the President for his signature and become law.
So, now the House of Representatives must vote again on virtually
the same bill it already passed, but with these minor, immaterial changes
made by the Senate.
OK, no problem, right?
If the House passed it before, they'll pass it again.
We hope. But there's a
snag. The House went home a
few days ago and is not officially scheduled to reconvene until January
31.
That gives the defenders of the status quo more than
a month to mobilize misleading propaganda against Medicaid reform and
sensible long-term care policy improvements.
Who are they?
o AARP
which seeks to divert Medicaid from the poor to its affluent members and
their heirs.
o NAELA,
the National Academy of Elder Law Attorneys, which seeks to preserve its
cash cow, legalized artificial impoverishment of well-to-do clients to
qualify them for Medicaid.
o Numerous
well-intentioned, but ill-advised advocates for the elderly and poor who
have been misled to believe their clients benefit from the existing,
utterly corrupt, system.
So what needs to be done?
Call Speaker Hastert at 202-225-2976.
Ask him to call the House back into session immediately.
The whole House could be back in DC, vote this package into law,
and return home in 24 hours. What a difference a day makes!
Ask your Congressman or Congresswoman to make it a
Merry Christmas and a Happy Hanukkah.
You can find their DC and local phone numbers at http://www.house.gov/.
Find them a flight schedule and urge them to wing their way into
history.
There is one other possibility to resolve this
impasse. House Minority
Leader Nancy Pelosi could call upon all members to approve the version
passed by the Senate in a unanimous voice vote.
That would not require members of the House to return to
Washington, DC.
Why would she do that?
To avoid the ire of her caucus if they are compelled to be uprooted
from home and hearth right before the Holidays just to fly to DC for a
vote. Representative Pelosi's
phone number is 202-225-4965 in DC and 415-556-4862 in her California
District.
Let's get this job done before we start the new,
election year, when everything will get much harder to do politically.
#############################
Updated:
Tuesday, December 20, 2005, 1:44 PM, (Pacific)
Dateline:
Seattle, WA
#############################
Urgent You Act, It's Now or Never
SPECIAL
ALERT
The
dark side of the Force has pulled out all the stops. The groups and individuals that seek to twist Medicaid away
from the needy and consume it for their own purposes are out in force.
They are fighting with everything they've got to defeat the Deficit
Reduction Act in the Senate.
If
you want to preserve Medicaid as a safety net for the poor and encourage
responsible long-term care planning for everyone else, then now's the time
to do something. We recommend
you drop everything right now and call your Senators, with special
emphasis on the ones listed below.
Tell
them to vote for Medicaid, for responsible long-term care planning, and
for the Deficit Reduction Act.
THE
NEXT 24 HOURS ARE THE WHOLE BALL GAME ON THIS!
Senator
Lincoln Chafee (R-RI), (202) 224-2921
Senator
Norm Coleman (R-MN), (202) 224-5641
Senator
Susan Collins (R-ME), (202)
224-2523
Senator
Mike DeWine (R-OH), (202) 224-2315
Senator
Mary Landrieu (D-LA), (202) 224-5824
Senator
Ben Nelson (D-NE), (202) 224-6551
Senator
Gordon Smith (R-OR), (202) 224-3753
Senator
Olympia Snowe (R-ME), (202) 224-5344
Senator
Arlen Specter (PA), (202) 224-4254
#############################
Updated:
Tuesday, December 20, 2005, 10:25 AM, (Pacific)
Dateline:
Seattle, WA
#############################
LTCI CONFERENCE, ETC.
LTC Comment: Following
below is a heads up about early registration for the Sixth Annual
Intercompany LTCI Conference. But
first . . .
THE CRUCIAL SENATE VOTE on the budget bill will
probably not come until tomorrow morning.
Keep an eye on C-Span 2 coverage of Senate proceedings just in
case. Nothing is more
important right now to long-term care service delivery and financing than
the outcome of that vote.
WHOM
DO YOU HAVE TO THANK for getting us so close to a major Congressional
victory on Medicaid eligibility reform and LTC Partnerships? Here's an opinion as expressed by Joe Lessen, Director of
Special Projects for Federal Affairs at America's Health Insurance Plans (AHIP).
Says Joe:
"On
a separate note, unfortunately David [Rosenfeld] will most likely never
get the credit he deserves for all the hard work he put in on the
Partnership Program. Very few
folks really know that David was the heart and soul behind the House
version and fought to keep the House version as the dominant one that made
it into the reconciliation package. I
know he is not asking for accolades, but it is a shame folks will not know
that the Partnership Program was doomed unless David was there to save it.
The Senate version was so radically different than the House's that
if the Senate version were passed, LTC Partnership Programs as we know
them would have been doomed. I
for one appreciate him being where he was to be our champion."
On
top of that, without David's tireless efforts since last January, the
provisions in the bill that will help give Medicaid back to the poor and
encourage others to insure privately, would have died aborning. Without those measures passing, the value of the LTC
Partnerships would be mostly neutralized.
Don't count chickens yet. But
one thing they can never take away from any of us is that we got this far.
Thanks to David Rosenfeld. He's
at david.rosenfeld@mail.house.gov
if you'd like to express your appreciation and cheer him on for the last
lap.
#############################
ON AN IRRITATING NOTE, Robert Pear's article in
today's New York Times ("Budget Accord Could Mean Payments by
Medicaid Recipients," http://www.nytimes.com/2005/12/20/politics/20health.html)
quotes Lawrence E. Davidow of Suffolk County, N.Y., president of the
National Academy of Elder Law Attorneys, thus:
"I'm horrified and surprised that Congress would
turn its back on middle-class senior citizens who look to Medicaid as a
safety net to pay for long-term care. . . .
[I]t's more likely that people who need long-term care will lose
their homes and everything they have worked a lifetime to acquire, because
they'll have to use their assets to pay for nursing home care."
That's a preposterous misrepresentation of the
pending legislation which truly will help us give Medicaid back to the
poor and encourage the well-to-do to plan responsibly for long-term care.
Coming from someone who makes his living creaming welfare benefits
for affluent clients and leading a 4000-member organization full of the
same ilk, it is a disgrace.
#############################
LAST
CHANGE FOR EARLY REGISTRATION. This
message from conference director Jim Glickman regarding the forthcoming
long-term care insurance conference speaks for itself.
This is an outstanding meeting.
I'll be there, meeting, greeting and presenting.
Hope to see you there too.
"This
Friday, December 23rd is the final day of early bird registration for The
Sixth Annual Intercompany LTCI Conference.
Please register by midnight Friday to save $100.
"To
view more information about this conference, go to www.ILTCIconf.org.
To register, please click on the button 'Registration' (which is
located near the bottom on the left hand side).
Then click on the appropriate link. . . .
"After
you have registered, please select the sessions you plan to attend.
It will be very helpful in planning the appropriate room sizes for
each session.
"Also,
please be sure to register for your hotel room using the conference
discount at the Hilton Anaheim by December 23rd.
After this date the conference rates may be much more difficult to
obtain or possibly not available at all.
You can register directly from the website by clicking on the
'Hotel' button. The
conference has arranged for a group discount from American Airlines.
Click on the airline link and enter the 'Discount Code': A3226AT to
receive a 5% discount.
"Finally,
on Wednesday night March 1st, the conference has arranged a new event, a
networking dinner with a gaming theme.
Please be sure to attend, as this event promises to be a lot of
fun. For anyone planning to
add some vacation time on to the end of the conference, we have arranged
for the Hilton Anaheim to provide rooms at only $99 per night for any of
the nights between Thursday March 2nd and Sunday March 5th.
"If
you have any questions, please feel free to contact me."
Jim
Glickman
818-867-2223
#############################
Updated:
Monday, December 19, 2005, 12:23 PM, (Pacific)
Dateline:
Seattle, WA
#############################
LTC BULLET: HOUSE
PASSES HISTORIC LTC REFORM; CENTER HELPS TIP BALANCE; AARP SPURNED
LTC Comment: The
U.S. House of Representatives approved LTC Partnerships and major Medicaid
loophole closures early this morning after Senate conferees went along.
All hinges on full Senate passage now.
Details follow.
At 6:00 AM Eastern, after pulling an historic
all-nighter, the House passed long-term care reforms that exceeded our
highest hopes. Bottom line,
we got everything the Senate proposed, plus everything the House proposed,
and then some. We're still on
tenterhooks, however, waiting to see if the full Senate will go along.
Stay tuned to C-Span coverage of the budget bill for the
suspenseful conclusion of this public policy cliffhanger.
Details below, but first this. Members of Congress who stuck their necks out to do the right
thing, spurning harsh, personal and demagogic attacks by AARP, deserve
tremendous thanks no matter what the final outcome in the Senate.
Joe Barton (R, TX), Chairman of the House Energy and Commerce
Committee, is a case in point. Sensitized to the importance of long-term care by bitter
personal experience in his own family, he fought tirelessly for rational
LTC policy reform. Dropped by
a heart attack only a few days ago, Barton rose again to address the House
in the early morning hours today advocating passage of Medicaid and LTC
insurance improvements. Bravo,
Mr. Barton. Get well soon!
No matter how dedicated and hard-working members of
Congress are, little happens without staff.
So kudos to David Rosenfeld and his colleagues who sheparded this
extraordinary legislation through to within a hairsbreadth of statutory
status. Rosenfeld co-founded
the Center for Long-Term Care Financing, our predecessor organization,
with Center President Steve Moses in 1998.
He fought unstintingly and against overwhelming odds to reach this
point. When last we
communicated, he'd been up over 36 hours straight in this closing round of
a long battle for these critical measures in the House.
Your Center for Long-Term Care Reform had a thing or
two to do with this progress too. We
spent half time in Washington, DC this Summer briefing (primarily) Senate
Finance Committee staff on the importance of these reforms. Our "Rule of Law" column titled "Welfare for
the Well-To-Do" ran over the weekend in the Wall Street Journal
and was widely circulated on Capitol Hill Saturday and Sunday before the
vote. Read on for a copy of
that op-ed. As you know,
we've repeatedly exposed AARP's irresponsible attacks on members of
Congress who seek to save Medicaid for the poor by diverting the affluent
to responsible long-term care planning.
And then this surprise this morning.
Even the New York Times is on board encouraging rational
long-term care reform. Their
editorial today, titled "The Long-Term Care Conundrum," while it
does not address last night's victories specifically, does conclude thus:
"Americans have to realize that there is no entitlement to
long-term care and that few employers include long-term care in their
health insurance packages. That thought should lead to two things: serious financial planning on an individual basis, and a long
national conversation about how much responsibility the government should
have in ensuring proper care for the elderly and disabled."
The Times rejects the idea that Medicare or Medicaid can
handle long-term care financing and urges personal responsibility and
individual financial planning. Congratulations to the "old gray lady" for
publishing some really good advice.
Now, what's happened?
Read it for yourself in the Conference Report on the Deficit
Reduction Act of 2005 at http://www.rules.house.gov/109/text/s1932cr/109s1932_text.pdf.
A summary of the parts affecting long-term care and Medicaid begins
on page 668 of that document. But
here are the highlights, always assuming final passage in the Senate
followed by President Bush's signature.
o Long-term
care partnerships allowed and expanded.
Great news, but it would mean little if Medicaid planning abuse
were not curtailed also as below. Why
buy LTCi to avoid Medicaid spend-down if it doesn't exist in the first
place?
o $500,000
cap on Medicaid home equity exemption with option for states and
politicians who dare to go up to $750,000.
o Medicaid
transfer of assets look back period extended from three to five years.
o Medicaid
planners' favorite "Half-a-Loaf" giveaway strategy ended by
penalty date change.
o Stronger
undue hardship protections to protect elders from financial abuse and LTC
providers may apply for hardship protection on behalf of Medicaid
residents.
o Transfer-assets-before-income
loophole closed.
o Use of
"Medicaid friendly" annuities restricted.
o Purchase
of "life estates" to qualify elders for Medicaid curtailed.
o Stops
an egregious Medicaid planning dodge that allowed exemption of Continuing
Care Retirement Community deposits of sometimes hundreds of thousands of
dollars.
o Requires
imposition of partial month's eligibility penalty thus ending some states'
policy of permitting monthly penaltyless transfers of one dollar less than
double the cost of private nursing home care.
o Allows
states to accumulate multiple transfers into a single penalty period thus
closing another abusive loophole.
o Prevents
abuse of certain loans, promissory notes or mortgages to hide assets to
qualify for Medicaid LTC benefits.
Even if these measures pass the Senate and become
law, this battle is not won yet. We
will have to fight to get the States to implement the provisions. We will have to fight to get the federal government to
enforce the new rules. We
will have to fight to prevent the Medicaid planners from circumventing the
law and regulations. We will
have to fight to educate the public that Medicaid is no longer an option
for the affluent. We will
have to fight for better education and stronger tax incentives to get
people to buy private LTC insurance and use reverse mortages.
We will have to fight for better reimbursement for LTC providers by
Medicaid and Medicare. But as
we struggle on, no matter what happens, the forces dedicated to ruining
Medicaid by stretching it to serve their own greedy ends have sustained a
big loss. We've won a major victory.
So celebrate in moderation, hope for the best in the Senate, and
get ready for the next stage of the battle.
Here's the text of my Wall Street Journal
op-ed published over the weekend.
December
17, 2005
RULE
OF LAW
Welfare
for the Well-to-do
By
STEPHEN A. MOSES
December
17, 2005; Page A11
With
expenditures topping $300 billion and rising 8% annually, Medicaid is a
huge entitlement -- larger even than Medicare.
State governors in particular are howling that their share of the
overall costs -- 43% -- are burning through state budgets uncontrollably.
As Virginia's Mark Warner put it, "We are on the road to a
meltdown."
Now,
as the first session of the 109th Congress winds down, House and Senate
members are attempting to hash out a compromise in conference that could
provide some overall budget relief. The
spoiler is AARP, which is dispensing clouds of self-serving rhetoric while
attempting to divert the program's scarce resources to the senior lobby's
more affluent members. What's
going on?
Most
people think of Medicaid as the health-care payer of last resort for poor
women and children. But
long-term care is Medicaid's biggest single cost -- and many recipients of
this largesse are anything but poor.
One reason is that, for purposes of Medicaid nursing home
eligibility, people are allowed to retain unlimited income as long as
their medical expenses -- including long-term care -- are high enough.
Another big reason is that they can also keep unlimited assets in
the form of home equity, a business or other kinds of wealth.
In
theory, once they die the government could recover Medicaid costs from
their estates. In practice,
most of this wealth disappears, often in gifts to family members.
Consider
home equity, seniors' largest asset.
According to the National Council on the Aging, 81% of America's
13.2 million householders aged 62 and over own their own homes, and 74%
own their homes free and clear. Altogether,
seniors possess nearly $2 trillion worth of home equity.
Yet, by the time they apply for Medicaid, few own their homes.
Are they giving the homes away to their grown-up children or other
relatives? Such a transfer of
assets carries no legal penalty as long as it is done at least three years
and a day before applying for Medicaid.
That's
just one of hundreds of eligibility "loopholes" that allow
individuals, especially those advised by Medicaid planning attorneys, to
qualify for Medicaid long-term care benefits without spending down their
own wealth for care. If you
doubt this, try an Internet search for "Medicaid planning" and
read some of the sales pitches on the more than six million hits.
You'll learn how to purchase noncountable assets, buy and give away
a string of luxury cars without penalty, hide wealth in exempt annuities,
sell your ailing parent a "life-care contract," even buy a farm
or business -- all for the express purpose of "impoverishing"
yourself or a loved one artificially and qualifying for Medicaid long-term
care benefits.
Ten
Congresses and four presidents have tried to stop these legal scams.
They've closed loopholes, discouraged Medicaid qualifying trusts,
made recovery from recipients' estates mandatory, and offered tax
incentives to encourage private insurance.
They even criminalized Medicaid planning in 1996, only to be
accused of "throwing granny in jail." When they repealed that
measure and replaced it a year later with another to "throw granny's
lawyer in jail," the law was deemed unconstitutional.
Congress
is trying Medicaid reform once again.
The House of Representatives recently passed legislation to curtail
a few of the most egregious abuses. It
would move the look-back period for asset transfers from three to five
years, eliminate Medicaid planners' favorite "half-a-loaf"
giveaway strategy, and cap exempt home equity at $750,000. Even if these measures move out of the conference committee
with the Senate and become law, elderly Americans could still give away
$10 million (actually unlimited assets) without penalty five years and one
day before applying for Medicaid. They
could still retain a home worth three-quarters of a million dollars while
getting taxpayers to pick up the costs of their long-term care.
AARP
has nevertheless gone ballistic, claiming that the House reforms
"seriously threaten the ability of millions of Americans to get
needed long-term care services" and "will deny millions of older
and disabled Americans the long-term care services they need and leave
them vulnerable to substandard care."
They've targeted members of Congress with advertisements in their
hometown papers attacking the House's efforts to curtail Medicaid abuse;
they've run radio and TV spots, and full-page ads appear in Capitol Hill
papers almost daily. House
staffers report that scared and angry AARP members have been deluging
members' offices with calls and letters parroting AARP's distortions and
hyperbole.
AARP's
position and tactics are wrong, hurtful and dangerous.
Preventing asset giveaways to qualify for public assistance does
not threaten one's access to quality long-term care:
If people keep their wealth instead of giving it away, they will
command red-carpet access to top-quality care in the private market
instead of becoming dependent on Medicaid's low-cost nursing home care of
highly questionable quality.
Denying
public welfare to people with three-quarters of a million dollars in home
equity does not reduce their access to care.
With a reverse mortgage, such people can tap their home equity to
pay for long-term care, or indeed to pay for private long-term care
insurance. As private payers,
such people will have better access to a wider range of higher quality
long-term care services than they would have as Medicaid dependents.
The
more fundamental questions to ask are why Medicaid should be used as a
kind of inheritance insurance for middle-class baby-boomer heirs -- and
how this practice protects Americans most in need?
AARP's resistance to Medicaid reform anesthetizes boomers to the
risk and cost of long-term care at the very time in their lives when they
should be saving, investing and insuring against such risks.
It lines their pockets now at the expense of taxpayers, to the
detriment of the poor, and with a huge risk to Medicaid's solvency.
Boil
it all down and you're left with only one conclusion. Faced with the choice of supporting the use of Medicaid for
people genuinely in need, or grabbing what it can for its well-heeled
members and their heirs, AARP took the low road.
Mr.
Moses is president of the Center for Long-Term Care Reform in Seattle.
URL
for this article:
http://online.wsj.com/article/SB113477649883625141.html
#############################
Updated:
Friday, December 16, 2005, 2:03 PM, (Pacific)
Dateline:
Seattle, WA
#############################
WATCH
FOR MOSES OP-ED IN WSJ TOMORROW (SATURDAY)
SPECIAL ALERT
Tomorrow's Saturday edition of the Wall Street
Journal will contain my op-ed regarding Medicaid reform proposals
under consideration in Congress.
According to the Journal, my piece will run in
the "heavily-read Rule of Law column which runs Saturday
morning."
If you miss it, we'll fill you in on Monday, but just
in case you'd like to pick up a hard copy, this is your "heads
up."
Thanks as always for your support and encouragement
of our work at the Center for Long-Term Care Reform.
Steve Moses
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