Perhaps the most constructive thing the new federal commission can do is to facilitate state experimentation with social insurance programs that encourage people to plan ahead for and contribute to their long-term-care needs.
Noting the broad waiver authority the administration has under section 1115 of the Social Security Act, Congress could endorse the idea of state waivers that would allow states that pursue social insurance programs to share in federal Medicaid savings that result; Congress also should give states incentives to use registries, care coordinators and other parts of their Medicaid infrastructure to serve a general population in need of assistance navigating the long-term-care marketplace. Both of these would be significantly more cost-effective than additional tax breaks for private long-term-care insurance that, by themselves, generate very little new enrollment.
Although the need for a broader national approach to long-term care remains urgent, the next few years may be a time to focus on what states can do to complement changes in the delivery system as we implement the health care overhaul. Addressing long-term services and supports is not an all-or-nothing proposition. It is not necessary to address all the risk that individuals face to improve the current situation. In the face of federal paralysis, there may be political and practical wisdom in focusing on incremental changes at the state level. In short, this could be a good time to make lemonade.
Lee Goldberg is vice president for health policy at the National Academy of Social Insurance.