The New Year’s Day fiscal cliff deal included many provisions that are of interest to those working with seniors and those with disabilities. Among changes to the income tax and estate tax systems, the fiscal cliff deal impacts the long-term care community. The fiscal cliff deal repealed the CLASS Act, a provision of the Affordable Care Act that aimed to create a voluntary, federal long-term care insurance option.
Importantly, the fiscal cliff deal also establishes a Commission on Long-Term Care. The deal’s creation of this Commission represents the first time Congress has established a comprehensive evaluation of long-term supports and services since the U.S. Bipartisan Commission on Comprehensive Health Care (the Pepper Commission) more than twenty years ago.
The Commission on Long-Term Care is assigned with the task of developing a “plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports” for older Americans and individuals with disabilities. It is asked to account for demographic changes, address gaps in Federal and State infrastructure, and identify improvements to health care programs and the workforce to ensure the delivery of high-quality services.
The Commission will investigate the interaction between Medicare, Medicaid, and private long-term care insurance. The Commission will consist of fifteen members with the President, Senate Majority Leader, Senate Minority Leader, Speaker of the House, and House Minority Leader each appointing three members. This will result in nine Democratic appointments and six Republican appointments. Members of the Commission will represent the interests of consumers, older adults, family caregivers, health care workers, private long-term care insurers, State insurance departments, and state Medicaid agencies. Within six months of appointing the members, the Commission must vote on a long-term care proposal. The following individuals have been appointed to the Commission. Please note that Judith Stein, appointed by Congresswomen Pelosi, was the lead attorney in the recent Jimmo class action settlement regarding the removal of Medicare’s so called “improvement standard.”
House Minority Leader Nancy Pelosi (D-CA):
- Bruce Allen Chernof, M.D., President and CEO, The SCAN Foundation
- Judith Stein, J.D., Former NAELA President; Executive Director of the Center for Medicare Advocacy, Inc.
- George Vrandenburg, Co-founder and Chair of USAgainst Alzheimer’s
Speaker John Boehner (R-OH):
- Judith Brachman, a former director of the Ohio Department of Aging.
- Stephen Guillard, President, Belmont Nursing Corp.; Executive Vice President and COO of HCR ManorCare. Recent chair of theAlliancefor Quality Nursing Home Care.
- Grace-Marie Turner, President and founder, Galen Institute.
Senate Majority Leader Reid (D-NV):
- Javaid Anwar, M.D. internal medicine
- Laphonza Butler, President of SEIU United Long-Term Care Workers union
- Judith Feder,GeorgetownUniversity, professor of public policy; former Dean, Public Policy Institute atGeorgetown
Senate Minority Leader Mitch McConnell (R-KY):
- Bruce Greenstein, Louisiana Health Secretary.
- Neil Pruitt, Chairman and CEO of UHS-Pruitt Corporation and Chairman of the American Health Care Association.
- Mark Warshawsky, Former Treasury Assistant Secretary for Economic Policy (President George W. Bush).
President Barak Obama (D):
Henry Claypool, Executive Vice President of the American Association of People with Disabilities
- Julian Harris, Massachusetts Medicaid Director
- Carol Raphael, Vice Chair of the American Association of Retired Persons (AARP) Board of Directors
So what could the Commission ultimately achieve? Some experts are very skeptical of the Commission’s ability to accomplish much. However, the panel can achieve at least two important goals – defining the problem and broadly framing future solutions.
Just getting a bipartisan commission of Congress to acknowledge the importance of the challenges facing those receiving long-term supports and services and their caregivers would be a huge step forward. Acknowledging that our current system of financing and delivering this care is terribly inadequate would be another big step. And defining the roles of government programs such as Medicaid as well as private insurance would be yet another significant achievement.
However, the Commission does have obstacles. The Commission has only six months to make proposals to Congress. The panel has no funding and will have to rely on staffers from Congress and the executive branch. Even if the panel could reach a consensus, there is no requirement that Congress ever vote in its plan.
Still, at least this is a move in the right direction. Let’s wish the Commission the best of luck in order to carry out its mission.