Genworth Financial hosted a long-term care (LTC) symposium in Washington, DC on May 7. The symposium focused specifically on the issues surrounding financing long-term care. Also discussed were education, access, caregiver support and other issues.

The symposium on May 7 followed an April 7 conference, also in Washington, hosted by Rep. Tom Suozzi (D-NY). Rep. Suozzi is the principal author of a bipartisan long-term care bill, the WISH Act, H.R.2082, a bill that would create a public-private partnership to make long-term care more accessible and affordable. Rep. Suozzi spoke at the Genworth symposium, emphasizing the need to address the growing problem of affordable long-term care for what is projected to be some 70 million aging baby boomers.

Panelists on four different panels and video clips from home care providers spoke about the growing need for long-term care, and the problems associated with accessing it. Chief among them, all the speakers agreed, are affordability, awareness of the need at an age young enough to deal with it (by purchasing long-term care insurance or by saving money in case of need), and accessibility—finding out about and analyzing the resources available to address long-term care needs. Also discussed was the need to make the personal/direct care workforce a profession of respect and enough compensation to allow caregivers to support their own families,

Among the suggestions offered by the panelists and video speakers were:

• Educate the public about the need to plan for long-term care needs—make it as much of a “non-discretionary” need as property insurance, or terrorism insurance
• Make LTC an “inter-generational” issue—one as important to and impactful on younger people as on older people—this will create a bigger risk pool and thus lower the overall costs associated with meeting long-term care needs
• Create a public-private partnership, with private resources (including insurance) used for an initial period of long-term care needs, and the government responsible for “catastrophic” (after a certain number of years (five? seven? more?) long-term care costs
• Integrate LTC planning with retirement planning
• Discuss the fiscal trade-offs involved in public financing of long-term care expenses—the more people in the general public find it a “non-discretionary need,” the more likely government (federal and/or state) will be to allocate the resources (taxes? direct expenditures?) to meeting the need
• Create federal standards and resource guides to make the system less confusing, especially when people confront it at a “crisis point” in their/their loved one's lives
• Support caregivers—those who are caregivers by profession, and those who are family caregivers—this pulls in immigration reform issues, compensation issues, and training issues, the speakers pointed out

Several speakers noted some of the problems confronting action on this issue. One, from the CATO Institute, noted that the primary financer of last resort, Medicaid, was designed to help poor people who could not help themselves. He questioned the fairness of taxpayers shouldering the cost for a Medicaid program that allows people to spend down to qualify for Medicaid when they in fact had assets that could have provided for the cost of long-term care. Another speaker noted the need to take a close look at Medicaid qualification requirements, alleging that there are many ways to get around the spend down rules so that Medicaid pays for the cost of long-term care even though there are assets available to pay for it.

All the speakers agreed that there is an important role for long-term care insurance in meeting long-term care needs. But they also noted that the industry has had to pull back as catastrophic needs/claims undercut their initial underwriting. A public-private partnership, with the government (federal and/or state) picking up the catastrophic costs could help solve this problem, they said.

The WISH Act, cosponsored by Rep. John Moolenaar (R-MI), would provide for a government subsidy of the cost of long-term care after a waiting period of one to five years (depending on the beneficiary’s income level). This year’s version is silent on how to pay for the program. In years past, Rep. Suozzi suggested a payroll tax as a financing mechanism. Reps. Suozzi and Moolenaar are looking for ways to contain the WISH Act’s cost. Among them are changing the five waiting periods (based on income) to two and authorizing a cash payment WISH benefit rather than direct payment of LTC costs. No decisions on that have been made yet.

Prospects: Discussions about long-term care needs and the costs associated with them (and how to pay those costs) have been ongoing for literally decades. However, with the U.S. population aging (symposium panelists said that 20 percent of the population is currently over age 65), and with passionate support from certain lawmakers who are working at growing yet more passionate support both in the public and among their colleagues, the panelists thought the timing may be right to actually do something about the issue.

The issue faces headwinds in Congress, despite growing concern among lawmakers from both parties and in both chambers, about the cost and accessibility of long-term care. The issue is competing with spiraling federal deficits and ever-louder calls for spending cuts. Congress must deal with reconciliation legislation, government funding legislation, and a host of other priority issues (foreign policy, immigration, disaster aid, etc.) It may take more time before the issue rises to a spot on lawmakers’ priority list that allows for legislative action..

NAIFA Staff Contact: Jayne Fitzgerald – Director – Government Relations, at jfitzgerald@naifa.org.