Health Affairs

Great struggles sometimes result in unexpected opportunities. In the waning moments of 2012, Congress remained in session to bridge partisan divides to solve the fiscal cliff impasse with the passage of the American Taxpayer Relief Act (ATRA). Signing the ATRA into law also achieved policy change on items far beyond the tax code.

For example, the new law repealed the Community Living Assistance Services and Support (CLASS) provision in the Affordable Care Act, which would have created a new, national, voluntary, long-term care insurance product. Yet the problem of how to best finance and deliver care for our vulnerable loved ones has been looming for years and endures. As a much-needed acknowledgment of this, the Congress created a new Commission to propose policy solutions to address the long-term care challenges that a growing number of Americans face.

Given the sheer magnitude of this issue, the current political climate, and the short time span for turning around a meaningful legislative proposal (six months), the Commission’s charge is nothing short of colossal. However, its creation in the wake of the CLASS repeal is an important step towards system transformation that will enable Americans to age with dignity, independence, and choice. The Commission will consist of 15 appointees, nine Democrats and six Republicans, to be named in the next month, who will report back to Congress by the summer. They must devise a plan on the financing and delivery of a comprehensive and coordinated system that ensures available long-term services and supports for people in need today, and options for Americans to plan for their future needs.

Time travel, both backward and forward, continues to be a favorite theme in popular culture. If we could travel back just 60 years or so, we would see a vastly different health care system, one geared to provide acute care, not chronic care, and one offering what today would be seen as rudimentary treatments. No one in 2012 would expect a surgeon to use techniques from that era or a doctor to prescribe medications long surpassed by more effective drugs. Yet one important area of health care and long-term care services and supports clings to outmoded terms and measures.

Welcome to the hidden world of family caregivers — broadly defined as the spouses, adult children, other family members, partners, friends and neighbors who provide or manage most of the care of the growing number of noninstitutionalized people with chronic illnesses and disabilities. As our recently released AARP Public Policy Institute and United Hospital Fund report (available here and here) puts it:

Family caregivers have traditionally provided assistance with bathing, dressing, eating, and household tasks such as shopping and managing finances. While these remain critically important to the well-being of care recipients, the role of family caregivers has dramatically expanded to include performing medical/nursing tasks of the kind and complexity once provided only in hospitals.

These tasks include managing multiple medications, not just pills but injections and infusions; wound care; operating medical equipment like feeding tubes, dialysis machines, and mechanical ventilators; and using electronic monitors and other devices.

One of the goals of the Affordable Care Act (ACA) is to reduce the fragmentation of services for patients. The problems of fragmentation are magnified for the six million Americans receiving long-term services. New analysis, released as a Web First by Health Affairs, examines the impact on this population of three provisions of the ACA—the... Read the rest of this entry »

Now that the Obama Administration has suspended implementation of the CLASS Act, what long-term care financing system should take its place? That is the question that Gloria Eldridge and Joanne Lynn address in the most-read Health Affairs Blog post for November. The November most-read list also features posts about reducing health care spending. For example,... Read the rest of this entry »

Editor’s note: A newly updated Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation provides more information on the CLASS Act and where we stand now regarding the need to provide affordable coverage for long-term services and supports. The announcement by U.S. Health and Human Services Secretary Kathleen Sebelius that the Community... Read the rest of this entry »

Flu vaccination rates among nursing home residents have improved slightly, particularly for blacks. Nonetheless, overall vaccination rates remain well below the 90 percent target for high-quality care, and black nursing home residents remain less likely to be vaccinated than whites, say Shubing Cai of Brown University and coauthors in the October issue of Health Affairs. The article... Read the rest of this entry »

As has been widely reported, the Department of Health and Human Services announced on Friday that they would stop implementing the Community Living Assistance Services and Supports (CLASS) program the long-term care program included in the Affordable Care Act. “For 19 months, experts inside and outside of government have examined how HHS might implement a... Read the rest of this entry »

When making health care choices, is there a relationship between what health care consumers pay and the quality of services they receive? While this has been long debated, a soon-to-be published survey commissioned this year by the California HealthCare Foundation (CHCF) found uncertainty about the relationship between the cost and quality of care. The survey... Read the rest of this entry »

A posting on the Health Affairs blog earlier this year by Carol Levine asked the pointed question: “The year of the family caregiver- in what country?”  In it, she compared the “Year of the Family Caregiver” in the U.S. to the recent elections in Canada, where politicians were competing to see who could provide a... Read the rest of this entry »

The “Bipartisan Plan to Reduce our Nation’s Deficits” developed by the “Gang of Six (or Seven)”, a group of Senators from both parties, certainly is not something I would brag about before a group of Princeton students who, I routinely tell them, will have to grow up quickly to clean up the mess their parents... Read the rest of this entry »

As has been widely reported, the bipartisan group of Senators known as the “Gang of Six” today unveiled a long awaited framework to reduce the nation’s projected debt by $3.7 trillion over ten years. The plan presented by the group — which includes Democrats Conrad (ND), Durbin (IL), and Warner (VA) and Republicans Chambliss (GA),... Read the rest of this entry »

The latest Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines the Community Living Assistance Services and Supports (CLASS) Plan, a voluntary, publicly administered insurance program enacted as part of the Affordable Care Act in 2010. It is designed to help people should they become disabled and need long-term services and... Read the rest of this entry »

Michael Ogg’s Narrative Matters essay in the January issue of Health Affairs “powerfully illustrates the realities of the current long-term care environment,” Rep. Frank Pallone (D-NJ) said yesterday at a House Energy and Commerce Health Subcommittee hearing.  Pallone, the panel’s senior Democrat, entered the essay into the hearing record. Ogg suffers from primary progressive multiple... Read the rest of this entry »

Health Affairs has launched The Care Span, a new ongoing section of the journal, in its March 2011 edition. The Care Span will examine the topics of aging and disability, not as isolated experiences but as part of the full span of life. Toward this end, the journal aims to bring together the best current... Read the rest of this entry »

Major changes lie ahead in the structure and delivery of long-term health care services and supports, accelerated by the Affordable Care Act. Among these are expanded options for people to receive services in their homes and communities; care coordination for the disabled population dually enrolled in Medicare and Medicaid; and the creation of a new... Read the rest of this entry »

On Tuesday morning, March 8, please join Health Affairs at the W Hotel Washington for a briefing tied to the release of the March 2011 issue of the journal, “Profiles of Innovation in Health Care Delivery.” You can also follow the briefing on Twitter through live Tweets at #HA_Innovation on HA_Events.  Topics covered in the issue... Read the rest of this entry »

Editor’s Note: See this subsequent post for an updated speakers list and information on following the event through Twitter. On March 8, 2011, please join Health Affairs for a briefing tied to the release of the March 2011 issue of the journal, “Profiles of Innovation in Health Care Delivery.”  Topics covered in the issue and... Read the rest of this entry »

In a speech last week at the Kaiser Family Foundation, Health and Human Services Secretary Kathleen Sebelius said that the Administration was looking at ways to buttress the financing of a new long-term care insurance program included in the Affordable Care Act. This comes in response to concerns raised by President Obama’s National Commission on... Read the rest of this entry »

Editor’s Note: For more on informal caregivers and related issues, see Bridging Troubled Waters: Family Caregivers, Transitions, And Long-Term Care and other articles in the January issue of Health Affairs, titled Advancing Long-Term Services & Supports.  The primary focus of this analysis is to examine trends and key findings for caregivers of persons 50+, with an... Read the rest of this entry »

Here in DC we’re bracing for the storm of the century — snow storm, that is.  What better time to catch up on some health policy reading? We list here the top 10 most-read posts from January on Health Affairs Blog. Topics cover health reform, health care costs, the mammography guidelines controversy, and more. And... Read the rest of this entry »