Long-Term Home Care Seen as Key Part of Health Plan

WASHINGTON —  In a major new health care initiative, President Clinton has tentatively decided that every severely disabled American, regardless of age or financial means, should have insurance coverage for long-term care at home, sources said Tuesday.

The new $15.4-billion annual benefit is to be included in the core package of medical insurance benefits being designed by the Administration as a nationwide standard for all Americans, especially the estimated 37 million without insurance, sources said.

The long-term care coverage would provide all eligible Americans assistance with at-home activities of daily living, such as meal preparation, cleaning and dressing.

Many details of the program remain unclear, such as how the White House Task Force on National Health Care Reform, chaired by First Lady Hillary Rodham Clinton, arrived at the cost figure and how specifically the program is to be paid for.

Health care analysts say that as much as 80% of long-term home care is now provided for free by relatives and friends.

“It’s very easy to spend $30,000 to $40,000 a year on intensive home care, but the average figures are a lot lower than that--in part because people don’t get enough. That’s why all the numbers are so soft,” said Edward F. Howard, executive vice president of the Alliance for Health Reform, a nonpartisan, not-for-profit Washington organization.

The emerging basic benefits package, which is also expected to cover mental health services and elective abortions, is at the core of the overall health care reform agenda that the President is expected to unveil in mid-June.

That the President has tentatively decided to include long-term care in the basic benefits package is not a surprise, although it marks a dramatic new turn in federal health policy.

Administration officials, most notably Mrs. Clinton, have strongly argued that long-term custodial care at home is much cheaper than that provided in a health care institution or a nursing home.

The long-term care program is expected to be vigorously supported by such powerful groups as the American Assn. of Retired Persons--but just as strongly opposed by the insurance industry, which would like to see private insurers continue selling such policies.

Whether the long-term care program will gain widespread middle-class support remains to be seen.

On the one hand, the cost of the President’s health care reform could reach $90 billion or more a year, and that could sap popular support for his agenda, including the long-term care coverage.

Yet key Administration officials view long-term care as a family issue that cuts across generations and they are known to believe that such coverage would gain the support of members of the middle class because it affords them a new measure of peace of mind.

“Protection from the high cost of long-term care increases the public’s willingness to support and pay for health care reform,” said Judith N. Brown, who chairs AARP’s board of directors.

An estimated 7 million disabled Americans need help annually with basic daily tasks, and that number may double by the year 2030, according to Sen. William S. Cohen of Maine, the ranking Republican member on the Senate Special Committee on Aging.

Today, nearly half of all long-term care costs are paid for out-of-pocket by those in need or their families.

The high costs of such labor-intensive care often wipes out the life savings of those without long-term care coverage, forcing them into Medicaid programs to make them eligible for government-subsidized nursing home care.

The Administration’s long-term goal is to provide coverage for institutional care as well.

One top insurance industry official called it “a fundamental mistake” to include long-term care for all disabled Americans regardless of age or wealth.

“Those who can afford to care for themselves should attempt to take care of themselves,” he said, asking to remain anonymous.

According to one set of options prepared for the President by his task force working group on long-term care, purchase of such coverage could be voluntary.

During a recent closed meeting with members of Congress, Mrs. Clinton cited as one model for the White House a program in Wisconsin that began in the mid-1980s called Community Options Program.

It now serves 11,300 disabled persons. And by keeping them out of more expensive nursing homes or other institutions, the $71.6-million program is saving an average of more than $100 million annually, officials said. COP has a two-year waiting list of 3,700 persons.

The program uses personal case-managers in each county and is often tailored to each individual.

A similar program in Arkansas, which also has served as a paradigm for the Administration, has 10,000 beneficiaries, many of whom are costing the state $300 a month instead of $1,200 a month for intermediate care in a nursing home, officials said.