BRANDON, William P.
Social insurance financing for long-term care : creative public policy to halt pauperization of the elderly and disabled in nursing homes - New York : Marcel Dekker, 1997
Long-term care (LTC) in institutions is one of the last major remaining gaps in the social insurance safety net provided to beneficiaries of Social Security.(1) However, Medicaid pays almost half of the costs of nursing home care after institutionalized elderly or disabled persons become impoverished. Structural reasons make it impossible for private insurance to cover institutional LTC for the bulk of the elderly and disabled. The paper demonstrates that there is an efficient, equitable and feasible social insurance solution to this serious social problem. The second section details a plan for a Medicare Part C Trust Fund to cover extended stays in nursing homes by Social Security beneficiaries (virtually the entire elderly population and most of the long-term disabled). It involves: (1) maintenance of current government funding indexed to inflation; (2) a premium taken from the cost-of-living allowances (COLAs) due to beneficiaries in the years immediately after they qualify for Social Security; (3) a substantial copayment; (4) a deductible consisting of the first three months of nursing home care; (5) a two-year waiting period between qualification for Social Security and full LTC coverage. The three revenue streams will all increase automatically with inflation. The plan is designed to cover only institutional LTC costs in order to reduce complexity, minimize the price tag and maximize its political chances. However, it could be expanded to cover home and community-based care. The second half of the analysis explores the policy justifications supporting such a plan and considers the political reasons why this carefully crafted proposal might appeal to moderate conservatives as well as to progressives.
Social insurance financing for long-term care : creative public policy to halt pauperization of the elderly and disabled in nursing homes - New York : Marcel Dekker, 1997
Long-term care (LTC) in institutions is one of the last major remaining gaps in the social insurance safety net provided to beneficiaries of Social Security.(1) However, Medicaid pays almost half of the costs of nursing home care after institutionalized elderly or disabled persons become impoverished. Structural reasons make it impossible for private insurance to cover institutional LTC for the bulk of the elderly and disabled. The paper demonstrates that there is an efficient, equitable and feasible social insurance solution to this serious social problem. The second section details a plan for a Medicare Part C Trust Fund to cover extended stays in nursing homes by Social Security beneficiaries (virtually the entire elderly population and most of the long-term disabled). It involves: (1) maintenance of current government funding indexed to inflation; (2) a premium taken from the cost-of-living allowances (COLAs) due to beneficiaries in the years immediately after they qualify for Social Security; (3) a substantial copayment; (4) a deductible consisting of the first three months of nursing home care; (5) a two-year waiting period between qualification for Social Security and full LTC coverage. The three revenue streams will all increase automatically with inflation. The plan is designed to cover only institutional LTC costs in order to reduce complexity, minimize the price tag and maximize its political chances. However, it could be expanded to cover home and community-based care. The second half of the analysis explores the policy justifications supporting such a plan and considers the political reasons why this carefully crafted proposal might appeal to moderate conservatives as well as to progressives.
