Disability Action Center NW, Inc.

Congress: "End the Institutional Bias"

By Congressman Sherrod Brown
Link to Article

April 21, 2005

Thank you, Mr. Chairman, and welcome to Dr. McCLellan and our other witnesses. Mr. Chairman, I commend you for enabling the subcommittee to consider the future of long-term care. It is a critical issue.

However, Id like to suggest a subtle, but important, shift in perspective.

Instead of focusing on spiraling long-term care costs, lets focus on spiraling long-term care needs. Our population is aging and the need for long-term care is keeping pace. Lets focus on the actual issue, noton one of its manifestations.

If we frame this discussion around the need to reduce long-term care costs, we are basically saying that the cost of caring for individuals is more important than the individuals themselves.

If, on the other hand, we focus on the need for long-term care, we wont neglect important considerations. For example, we know that there are gaps in access to long-term care, particularly home and community-based services. Is that fact more or less important than the fact that long-term care costs are growing?

And we know that regardless of how these services are financed in the future, there are elderly and severely-disabled Americans who need long-term care today. Medicaid covers 70% of that care. If we cut Medicaid funding today, we place particularly vulnerable segments of our population at risk.

We can discuss reverse mortgages and long-term care insurance and personal responsibility until we are all blue in the face but the fact is that if we cut Medicaid today, we jeopardize the health and safety of real people. All our efforts to prepare for the future dont change that basic fact.

If you think Im being overly dramatic, talk to an elderly person in an under-staffed nursing home. Talk to her family.

Do we really think that todays nursing homes are filled with scheming seniors who are free-riding on the taxpayers dime?

There will always be people who work the system, but most Medicaid beneficiaries do not want to be Medicaid beneficiaries. They have no choice.

If we focus on long-term care needs rather than on long-term care costs, we will make sure our efforts to prevent asset transfers do not disenfranchise people in real need.

We will make sure that long-term care insurers do not cherry-pick or fail to deliver adequate benefits. We will think carefully before forcing people in an ownership society to give up their homes in order to get needed care.

Instead of focusing on how to reform Medicaid to address spiraling costs, lets focus on how to make sure every American who needs long-term care has access to it.

That means promoting private long-term care savings, and it means investing in Medicaid as a cost-efficient safety net for people in need.

Absent a universal long-term care system, there will always be people in need.

I understand Dr. McClellan will talk about the Presidents commitment to home and community-based care, and I share the Presidents enthusiasm for it. However, home and community-based care waivers typically have enrollment caps.

Making these waivers permanent, as the President has proposed, doesn't expand access to home and community-based care. Additional funding is needed to accomplish that.

I dont recall any increase in funding for home and community-based care in the Presidents budget. This care is very cost-effective, but there is unmet need outside the nursing home population. Expanding access will require additional dollars.

That does not mean we should give up on the idea of expanding access to home and community-based services. In fact, promoting access to these services should be a priority.

But championing the expansion of home and community-based care and at the same time pushing for cuts in Medicaid is like handing a person an umbrella, then pushing him off a cliff.

We cannot reduce the need for long-term care by reducing our current investment in it. It is certainly important to plan for long-term care needs in the future, but it is even more important to meet our long-term care commitments in the present.

If we are willing to cut Medicaid without regard to those we hurt, why even bother with this hearing? Apparently, the best way to reduce federal long-term care spending is to simply abandon those who rely on it.