Analysis: The 'Grannie Mae' solution?

By OLGA PIERCE, UPI Health Business Correspondent  |  June 12, 2007 at 5:59 PM
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WASHINGTON, June 12 (UPI) -- Paying for long-term care does not have to mean seniors -- and the country -- go broke, health experts said Monday.

A good system "supports life -- really living -- instead of simply staying alive," Christine Bishop, a health policy professor at Brandeis University, told scholars at an event sponsored by Georgetown University.

Under the current system, seniors who need care at home or in a nursing facility have to spend all their assets before they qualify for public assistance through Medicaid. Meanwhile, states and the federal governments, which finance Medicaid, are struggling to fill their current obligations for seniors.

Family members and other companions, who provide the bulk of care for the elderly, can be financially and otherwise burdened.

When baby boomers begin to need nursing-home care, that situation is likely to get worse.

But there could be a better way.

Advocates of change say combinations of private long-term-care insurance for the wealthy and a better safety net for the poor could make the system work for everyone.

"This is all about money," said Bing Chen, professor of Gerontology at the University of Massachusetts in Boston.

Chen has advocated a system, like that used in Germany, where everyone buys into public insurance to meet their basic long-term-care needs. For more comprehensive care, those who can afford it can buy private insurance, pay out-of-pocket or get care from family members.

"Public insurance (should) be a base upon which to build private insurance and resources from individuals and families," Chen said.

Other scholars argue for the opposite: a public-private partnership where private insurance covers nearly everyone and the government steps in to help the poor afford insurance.

"The idea is to stretch the public dollars," said Ann Tumlinson, a consultant at Avalere Health.

Another set of options are heavier on the public part of the partnership than the private.

The American Association of Homes for the Aging has advocated establishing an entity called "Grannie Mae" that would insure all Americans through payroll deductions. When it was time for nursing home or home care, the plan would pay out cash.

"Our vision is for all Americans to receive the care they need when they need it in a place they call home," said Barbara Manard, health policy researcher and consultant at the association.

A public entity would avoid the overhead costs and administrative burdens of private insurance, she said, and a program that pays cash would mean seniors could pay for unpredictable future needs.

"Think of a younger adult purchasing an insurance policy that won't be used for 40 years," Manard said.

Any systematic change, however, will mean addressing difficult questions of budget and politics, said Mark Meiners, director of the Center for Health Policy Research and Ethics at George Mason University.

"Financing is a big concern," he told United Press International. "We need to figure out a balance."

In a political landscape crammed full of healthcare issues, change for long-term care may also not make it to the forefront, he said.

"There's going to have to be political compromise, but I don't think long-term care will be able to leapfrog over other concerns."

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