An Interview with Hillary Clinton
by Mr. LTC
The Future of Long Term Care
"We need to take action ..."
Editor's note: In Oct. 1998, Martin Bayne put a series of questions relating to long-term care before the First Lady's Policy Office. What follows are selected highlights from that exchange.
Q: Your long standing commitment to long term care (LTC) reform has demonstrated this administration's sensitivity to the issues related to LTC. Socially and politically, how should we continue to address the problem of LTC financing for the average American?
A: Long term care is critical to millions of Americans' lives and will become even more so as our population grows older. Several steps can be taken to strengthen this system as we prepare for the next century.
First, we must raise awareness of the importance of long-term care. During the remainder of this year and most of next, there will be nationwide debates on Social Security and Medicare. Long-term care issues should be included in these debates, and debated on its own terms.
Second, we should encourage those that can save for and insure against long-term care needs. Unlike most acute care services, much of long-term care is currently provided by or paid for by families themselves rather than private insurance or public programs. Adding savings for long-term care expenses to retirement accounts and purchasing high-quality long-term care insurance are ways that middle class families can prevent devastating care costs.
Third, Medicaid remains an important source of long-term care for millions. Protecting this program from arbitrary budget cuts and continuing to improve its quality are high priorities of the administration.
Q: Do you believe in Congressional initiatives that would encourage the purchase of LTC insurance for young, working Americans?
A: Long-term care insurance is an important and growing source of coverage for long-term care expenditures. In the Health Insurance Portability and Accountability Act, we included provisions to encourage its purchase. We are just now learning about how this law is working, and will use those lessons to develop strategies to help younger workers protect against the cost of long-term care and ensure that these policies provide adequate protection.
Q: Given the enormous current expenditures for both nursing-home care and community-based care and the current population demographics, do you believe that states and individuals should take a more proactive role in promoting solutions to LTC financing, or is it realistic for American families to believe that someday the entire cost of LTC will be financed by the federal government?
A: Most agree that, given the strains on public programs as the Baby Boom generation retires, it is unlikely that the government can take on a large, new responsibility for long-term care. However, there are ways that the government can use its leverage to provide services more efficiently as well as encourage the use of affordable, high-quality, private-sector alternatives. We will continue to seek and promote such solutions.
Q: The president has consistently discouraged the use of Medicaid planning to "artificially" qualify for Medicaid. Do you personally support stronger measures to close the existing "loopholes" that some wealthy Americans use as an asset preservation strategy?
A: The administration remains concerned about people gaming the Medicaid system to preserve their wealth. The Balanced Budget Act of 1997 contained provisions that limit these loopholes. At the same time, Medicaid is critical for families who become impoverished by health care costs, and the president is committed to maintaining this important safety net.