Statement of Congressman John D. Dingell, Ranking Member
Committee on Energy and Commerce

SUBCOMMITTEE ON HEALTH
HEARING ON “LONG-TERM CARE AND MEDICAID:
SPIRALING COSTS AND THE NEED FOR REFORM”

April 27, 2005

As a Nation, we must develop a comprehensive long-term care policy in order to care for the 10 million people needing long-term care today and the millions more that will need care in the next 20, 40, and 60 years. It is an important but complicated issue that the Committee should be investigating, so I thank the Chairman for holding this hearing, as well as the witnesses who are here today to help educate us.

The majority of long-term care is provided free through family or friends. Of the services purchased, Medicaid is the largest payor and greatest safety net. It provides care for millions of elderly people and individuals with disabilities that had the misfortune of becoming ill and needing help with their basic activities of daily living. Sustained care is expensive and, without Medicaid, many people struggle with meeting their most essential needs, such as eating, bathing, or going to the bathroom.

Still, Medicaid always benefits from evaluation and updating. For example, we need to get rid of the program’s bias toward institutional living and provide for home and community based care where appropriate. Unfortunately, instead of talking about ways to shore up Medicaid as a safety net, many of our Republican counterparts are actually voting to cut it. The millions of ill people and individuals with disabilities who need long-term care services are a principal factor in the increasing cost of long-term care, not Medicaid. On the contrary, Medicaid continues to be one of the most efficient health care programs in the country.

The National Governors Association is united in their opposition to Medicaid cuts. They recognize that cuts will only harm States’ abilities to provide the care that we as a compassionate society need to offer. We should be helping both the people who depend on the program as well as ensuring that the States who manage the program are not harmed by our decisions.

Aside from public financing, there is also an insurance industry out there selling long-term care insurance. While they may be providing a vital and important service, we need to avoid the mess we found ourselves in with Medigap policies in the late 1980s. I do not want to be sorting through stories of unscrupulous insurers confusing and scaring beneficiaries into buying expensive policies that do little.

 I support long-term care insurance as an option, but there must be adequate protections. With standardized policies and consumer protections, such as inflation protection, non-forfeiture protections, and a minimum daily benefit, long-term care insurance can be a good and clear option for some. But some is the key word. Whether through “partnership” programs with Medicaid or by itself, long-term care insurance is not appropriate for millions of low- and modest-income families that are already finding it difficult to secure food, shelter, transportation, and health care, along with saving for retirement. Also, notably, creating incentives for the purchase of long-term care insurance may do little to alleviate the weight on public programs today.

We need to develop a coherent long-term care policy that preserves and expands the safety nets of today, not cut them. Thanks to all of you for taking the time to talk to us about where our priorities should lie.

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(Contact: Jodi Seth, 202-225-3641)