Abstract

Like most of the developed world, the United States has suffered economic recession and slow economic growth since 2008. This has adversely affected government revenues at the national, state, and local levels. In addition, with the shift of control of the House of Representatives to Republican Party control in 2011, federal policymaking in the United States has been stalemated. Nonetheless, the health reform legislation enacted in March 2010, set in motion several major initiatives, some of which may significantly affect how long-term care is financed and delivered. These initiatives include:

(1) a very large scale initiative to integrate medical and long-term care in managed care and managed fee-for service settings; (2) several new options for states to offer home and community-based services; (3) a new voluntary public long-term care insurance program (which the Obama Administration announced it would not implement because it could not be financially viable); and (4) a large number of demonstrations aimed at bundling payment for hospital, physician and short-term post acute care, encouraging home visiting by physicians to people with severe disabilities, and reducing unnecessary hospitalizations of nursing home residents.

A major focus of the presentation will be on why the enacted, but not implemented, voluntary public long-term care insurance program was determined to be not financially viable. An additional focus will be how states, who must balance their budgets annually, have altered their long-term care programs in the face of lower revenues and electoral victories by officials hostile to government programs.