Senate Special Committee on Aging Hearing: Health Care Reform in An Aging America

Wednesday, March 4, the Senate Special Committee on Aging, chaired by Sen. Herb Kohl (D-WI), held a hearing on Health Care Reform in an Aging America, with a specific focus on long term services and supports. Two panels provided testimony to the hearing. The first panel included Thomas Hamilton, Director, Survey and Certification Group, Centers for Medicare & Medicaid Services; Karen Timberlake, Secretary, Wisconsin Department of Health Services; and Holly Benson, Secretary, Florida Agency for Health Care Administration. The second panel consisted of Henry Claypool, Washington Liaison, PHI, New York, New York; Melanie Bella, Senior Vice President for Policy, Center for Health Care Strategies, Hamilton, New Jersey; and Judy Feder, Senior Fellow, Center for American Progress, Washington, D.C.

Aging advocates and advocates for individuals with disabilities filled the hearing room.

Senator Ted Kennedy (D-MA), who is leading the health care reform effort in the Senate along with Sen. Max Baucus (D-MT), issued the following statement at the hearing: "A major goal of health reform must be to give our citizens the chance to lead full and independent lives. That means that reasonable health care should include services to help individuals maintain their function and prevent deterioration of their condition --- just as it should cover services for acute illness and injury. So I join Senator Kohl in expressing the importance of including long-term services and supports in any health care reform initiative and applaud him for holding this hearing today."

Each of the witnesses provided insights into long-term services and supports and the importance of including long-term care issues in reforms to health care.

Panel One
Mr. Hamilton noted that Medicare and Medicaid together “comprise the single largest purchaser of long-term care.” He highlighted the partnership role that the federal government plays with states for financing long-term care, with families through Medicaid waiver home and community based services programs, with individuals with disabilities in the cash and counseling programs, with the private sector that employs the direct care workers, and with other federal agencies such as the Administration on Aging. He described the integral part that long-term services and supports plays in health care.

Secretary Timberlake related innovative programs in Wisconsin that manage care utilizing care teams to support nursing home eligible individuals who want to live in the community. She mentioned the cost savings associated with their long-term care programs. She particularly highlighted the Aging and Disability Resource Centers providing person centered access to information. “Long-term care must be a central issue of health care reform and entitlement reform,” she said.

Secretary Benson shared information about long-term care programs in Florida including Cash and Counseling, Medicaid Nursing Home Diversion and the Program of All-Inclusive Care for the Elderly. She provided some ideas for actions that Congress could take to help Florida’s efforts to improve long-term care including promoting coordination of long-term care services, investing in preventative services, and directing the Centers for Medicare and Medicaid Services (CMS) to develop a methodology to share savings with state Medicaid programs.

Panel Two
Henry Claypool urged the Senators to “move beyond making improvements in access to acute care services and embrace interventions that improve access to on-going services and social supports that allow individuals with limitations in activities of daily living to lead better and healthier lives.” As an example, he related that the cost to the Medicare program from treating the needs of those with functional limitations is three times that of a beneficiary without long-term care needs. “If we do not include this population – which consumes a significant share of our nations’ health care resources – Congressional efforts to address the growth rate of medical costs is likely to fall far short of its goal.” He recommended strengthening Medicaid and creating a new public insurance option.

Melanie Bella mentioned two major areas of opportunity: fully integrated care for dual eligibles and coordinated patient-centered home and community based services. Fully integrated care would combine acute care and long-term services and supports with one entity responsible for the financial and programmatic aspects of the program. She pushed for CMS to be encouraged to support fully integrated care models that states are testing.

Judy Feder urged broadening of Medicaid coverage of community based long-term services and supports, coordination of acute and long-term services and supports for those who are dually eligible for Medicare and Medicaid, adding a long-term care benefit to Medicare and establishing a voluntary public long-term care insurance program. Her advice was to act now to improve long-term care financing. “Assuring efficient, adequate and equitable long-term care financing is part and parcel of building our nation’s economic future,” she said.