Long-term care in Clinton plan may face trouble Cost to states could be sticking point

October 01, 1993|By Newsday

WASHINGTON -- Long-term care, a key selling point of President Clinton's health plan with the nation's seniors, could run into trouble because states, already burdened by Medicaid costs, will have to contribute to this new program as well.

"States will be looking at that tension between serving more of their population, and that it may cost them a little bit more," said Tricia Smith, senior health lobbyist for the American Association for Retired Persons.

In the plan unveiled last week, Mr. Clinton proposed a modest long-term care program that would eventually pay for home and community-based care for an estimated 2.5 million disabled people, most of them elderly. States would pay between 5 percent and 25 percent of the cost, based on the percentage they now pay for Medicaid, and the federal government would pay most of the balance. Recipients would make an income-based contribution ranging from zero for people with incomes below 150 percent of the federal poverty line to 40 percent for those at 400 percent above the poverty line.

The long-term care coverage, which administration officials estimate would cost $80 billion to $87 billion nationally over five years, would not kick in until the third year after the president's plan was enacted.

Mr. Clinton's plan would provide home and community services for disabled persons of any age who need assistance with such basic daily living tasks as getting out of bed, washing, eating or dressing.

It would also cover people with disabilities that might lead them to harm themselves.

It would not cover nursing-home care.

Senior advocates said yesterday they were worried that Congress, already concerned about paying for the program, might kill the long-term program as money gets tight. But those advocates warn that would not be politically prudent.

"From a political standpoint, it could be an absolute disaster," said Ron Pollock, head of Families USA, a consumer advocacy group that has been a strong administration supporter.

"The home-care provision in this legislation is probably the single most important provision for families with senior citizens, and to the extent that seniors are going to decide to support health reform, it will largely be predicated on this protection. If this is jettisoned, I think the plan will have very rough sailing."

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