What Happened to Long‐Term Care in the Health Reform Debate of 1993–1994? Lessons for the Future

Abstract

During 1993 and 1994, the United States debated but did not enact major health care reform. Although the reform efforts focused on providing health coverage for the uninsured and controlling acute care costs, many proposals included substantial long‐term care initiatives. President Clinton proposed creating a large home‐care program for severely disabled people of all ages and all income groups, among several other initiatives. By stressing non‐means‐tested public programs, the president's plan was a major departure from the Medicaid‐dominated financing system for long‐term care. In designing the long‐term care component, the Clinton administration addressed many of the basic policy choices that must be decided in all reform efforts, including whether initiatives should be limited to older people or cover people of any age, how to balance institutional and noninstitutional care, whether to rely on government programs or on the private sector, and how to control costs. Analyzing the political and intellectual history of long‐term care during the health reform debate provides lessons for future reform.

Long-Term Care over an Uncertain Future: What Can Current Retirees Expect?

“…While regulatory changes and subsidies could increase the role of private insurance somewhat, underwriting and limited demand constrain its ability to spread remaining uninsured out-of-pocket expenses. Public insurance could be enacted to spread the uninsured risk of incurring substantial outof-pocket expenditures, and many proposals have been suggested to do so (Rivlin and Wiener 1988;Scanlon 1992;Wiener et al 2001). The principal obstacle to doing so is political.…”

Opinion Networks Among Long-Term Care Specialists

“…A potential challenge in the adoption of LTC policy reform is competition among key constituency groups, including consumers, providers, public officials, and policy experts. Historically, there has been antagonism among members of these groups regarding issues such as financing, service delivery, and regulation (Weissert, 2008;Wiener, Estes, Goldenson, & Goldberg, 2001). This includes the desirability of individual versus societal responsibility for paying for LTC and the comparative efficacy of command-and-control versus market-based strategies for improving LTC quality.…”

Weighing Public and Private Options for Reforming Long-Term Care Financing: Findings From a National Survey of Specialists

“…In contrast to the debate surrounding President's Clinton's Health Security Act (Weiner et al 2001), LTC was neglected as an issue during the 2008 presidential campaign. Included in comprehensive health reform, the Patient Protection and Affordable Care Act (P. L. 111-148) signed into law by President Obama on March 23, 2010, however, is the Community Living Assistance and Services and Supports (CLASS) Act, which will establish a federal LTC insurance program paid for by voluntary payroll deductions (Watts, 2009).…”