Abstract

Long-term care financing in the United States has remained relatively stable over the last 25 years, despite many proposals for reform. Medicaid, the federal-state means-tested program for the poor, remains the main source of financing. In a major change, spending for post-acute, mostly rehabilitation-oriented care by the Medicare program, the universal government-run health insurance program for older people and some persons with disabilities, has skyrocketed. Although there has been an active private long-term care insurance market since the mid-1980s, only about 12% of older people have any insurance.

In recent years, the market has largely collapsed, largely due to the low rate of return on reserves. Finally, although there have been many proposals to establish a social insurance program, none has been enacted, reflecting the American ambivalence about the role of government.

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