Health Care thoughts: Obamacare Suffers Serious Set Back
Health Care thoughts: Obamacare Suffers Serious Set Back
The Community Living Assistance Services and Support (aka C.L.A.S.S.) is a lesser discussed but important feature of Obamacare (PPACA).
The Act requires the feds to set up a quasi-insurance self-funding mechanism for long-term care services (for more details see my write up at ISSUU/healthcarethinktank.
During testimony in February before the Senate Finance Committee DHHS Secretary Kathleen Sebelius admitted that as designed by Congress C.L.A.S.S. is not financially sustainable.
The battle now is whether or not Sebelius can 1) fix the Act via regulatory changes or 2) Congress must redesign the Act.
In the latest volley the Congressional Research Services says the regulatory powers are NOT broad enough for Sebelius to effectively rewrite the statute via regulation.
A bigger question remains for many of us, “can this program ever be financially sustainable?”
As predicted, with Obamacare the devil will be in the regulatory details.
Tom aka Rusty Rustbelt
(Dan here…lest opponents of PPACA get too excited, Rusty thinks the idea and some of the details of C.L.A.S.S. are a really good idea…)
I’ve been a proponent for something like this since the 80s.
Trouble is, a badly designed program may hurt the credibility of the entire concept.
Also, liberals seem to take on faith Obamacare will work. Try sketching a critical path for this legislation – there are lots of places the program can be derailed.
Complexity makes implementation more difficult – a nonpartisan comment.
Are we all going to have to purchase long term care? Or will it be just for the people who need long term care immediately? The private long term care business is in crisis mode right now due to losses. Ten years ago very few, if any, insurance companies knew how to price these policies correctly. Now they are facing unanticipated loss ratios and carriers are either raising their prices on new and exisiting business by as much as 40% or getting out of the business all together. And these aren’t little companies…more like household names such as John Hancock and MetLife. I was waiting to see the pricing/coverage details of the CLASS Act but I guess I’ll never get the chance.
Are we talking about what is popularly known as assisted living, that being the step before nursing home level of care? If that be the case here’s a personal anecdote that I think makes any insurance plan approach to the funding seem dim at best. I went to visit such a place only a few months ago hoping to find something that would suit my mother, 89 years old with perceptual and cognitice deficits. A lovely place. Care activities seemed a little infantalizing, but I’m probably too sensitive to that issue having spent over 20 years in adult residential care services for the developentally disabled. We didn’t like a child like approach.
Cost? At least $6,500 monthly for two to a small, but clean and pleasant enough, room. Medicaid doesn’t cover any part of the cost. How on Earth does an insurance scheme cover an $80,000 annual bill with an open end? Maybe I don’t have all the facts, but that’s how it was described to me by the administrator of in-take for the home.
So, it’s the same old story. Unless everyone buys some kind of long-term care insurance long before he needs it, no one can hope for some kind of government guaranteed coverage for open-ended care. This fact illustrates the difference between government and business (insurance or any other kind.) No way to make a profit on this. So, a perfect government function. Right? I don’t see a rationale for justifying cutting insurance companies in on this not very attractive proposition. So, why are we trying to push this elephant into a horse trailer? NancyO
I fail to see how anything called, “The Community Living Assistance Services and Support” could be “fiscally sustainable” per se. I don’t even know what that means. It’s not like the program itself has taxing power, does it?
This is a worthy, and interesting (and for me, timely) topic on its own, but it can’t be discussed on its own. As also worthy as any litttle piece, or incremental step needed to be worked out, and taken might be, in the big, health-care picture.. it’s wrapped up in an incomprehensible mess that is Obamacare.
“The battle now is whether or not Sebelius can 1) fix the Act via regulatory changes or 2) Congress must redesign the Act“
Redesign ? .. most of congress had no idea what they voted for in the first place .. **sigh** Is it reasonable to ask the public to trust un-voted-on regulation tweaking at that level, and of that scope ?
“can this program ever be financially sustainable?”
That’s what should have been asked about Medicare. If it were a piece of software, it failed in beta-testing. The first person entering the workforce as it was enacted.. ie.. the VERY first person to have spent his entire, working life paying into it; the VERY first cycle; is just now entering the payout phase; just a year or two into collecting on it, and it has long-since shown it cannot be sustained… Let’s see if we can make Medicare sustainable, and then sort through what’s do-able in Obamacare, and then carefully (with citizen/doctor input.. not by regulatory Czars) implement it.
What we’re doing now, is spinning our wheels in the face of opt-outs, Constitutionalty, and public distrust.
This is not insurance per se.
Read the Issuu post, has more detail.
Read the Issuu site for a concise explanation of the financing mechanism.
Thanks, O Lord of the Oxide. 🙂
Maybe Obamacare is an incomprehensible mess, but so’s your health insurance contract. Tried to read it? When you learn enough about the business to understand stuff like that, it’s time to seek help. People assume that Medicare is simple, so’s SS and Medicare. Point I’m making is that nothing is easy about the actual implementation of any law or regulation. After all, the ACA was written by a lobbyist hand picked by the health insurance companies. You sure can’t blame the government for messes that custom made by a lobbyist for maximum corporate profit. Piloting new software is easy compared to new government programs. Relax. There’s more where this came from and a lot of it will work out fine. NancyO
Mrs. Rustbelt was telling me this morning that I need help……………
Reid and Pelosi let lobbyists write the PPACA? Stop the presses!!!
Anyway, some of PPACA will work, but the critical path to meet the major objectives is long and very, very complicated.
Lord of the Oxide? Wow.
That is actually even at least as messy. If you accept costs in healthcare need attention, here in MA those interest groups you named can’t do so far with Romneycare…best so far is global payments. No matter the process it will be messy…I suppose we could argue one way or the other, but messy indeed. Regulatory Czars is simply a flame statement.
NanO, sure would like a reference for your statment. Who, what where was written by lobbyists?
Rusty said: “Anyway, some of PPACA will work, but the critical path to meet the major objectives is long and very, very complicated.” Agreed! So let’s rewrite it so those sections are maintained and those that will not work or are grossly inefficient are removed.
Oh, I forgot to add the kicker to the above anecdote regarding my initial investigation into assisted living costs. Due to the rather large sum of up front money required of someone entering the home I thought it prudent to look into the financial health of the company running the home. On the skids and sliding fast. And the place was near capacity. Is assisted living not a viable arrangement? A small room for two brings in about $160,000 per year to cover room, board and services. And it wasn’t working to the advantage of the company running the complex.
From what I could learn it seems that one company runs a number of such complexes and an independent corporation develops and owns the property. So now there are at least two stake holders in a home care complex. Maybe the entire enterprise needs to be reinvented. It seems not to be a money maker even with all that cash flow.
Not all assisted living organizations are so overpriced or screwed up (probably overleveraged),
The first Old Folks Home in the U. S. was started by a woman in Hartford, Connecticut. For $1,000 up front she would house, feed, and take care of her elderly residents for life. Life expectancy after entering the home: around 3 months. They finally convicted her of murder.
In Baucus’s budget committee. Who do you think writes law these days? Senators? NancyO
You hit the key, Dan… our problems in health-care are the costs themselves; not how to pay them. When the dust settles, a giant new branch of government, and outrageous taxation, is no better than outrageous premiums. We (and our government) need to go at this as though health-care is a product (’cause it really is), and laws/regulations need to address it as such,, make the market more inviting, get the supply/demand ratio working FOR us.. and maybe tax-credit the whole thing… or some sort of hybrid utility, where profits are maitined, and products are affordable ? A multi-trillion dollar NEW entitlement program is insane… at least until we can get Medicare on a sane, sustainable, autopilot.
Now, what can we suppose would happen; if the next, progressive plan to relieve us of being responsible for the expensive necessities of life ends up being Universal Auto-Care (we’re living through what, “mortages for anyone” caused). There’s surely a rational argument that requires safe, reliable automobiles for everyone. What can we assume will happen to the quality, innovation and cost for a product that’s already bought and paid for, before it starts down the assembly line (ala Medicare, its state and the cost of the product it pays for)? And the issue that worries me most.. is what this is all doing to the coming field of potential doctors ? Existing doctors are already opting out of government run health-care. I for one, would steer my bright child, well clear of a future as a veritable, civil-servant.
Sorry if you think “Regulatory Czar” in combustible. I’ll be more careful.. but given the power she/they will/are have/having, over an important part/parts of my life, well outside accountability, I think it fits.
We agree, Nancy. Private insurance (for reasons similar to my reply to Dan), is a horrid mess, too.
As to not re-type much of my last post to Rdan.. I’ll just say that turning to government to solve these things has historically made them worse. Medicare has evolved into a program on course to devour the entire federal budget, and it’s not even one cycle old.. it’s in it’s “trail period” and has failed, not only fiscally, but by running succesful doctors out of it. I’ll dig up the stats on just what percentage are no longer accepting Medicade/Medicare as payment. As a pilot needing a regular physicals, I can tell with certainty.. doctors know how this works… and what’s in store for them. My favorite flight examiner has been stripped of his FAA certification, BECAUSE he no longer accepts Medicare/Medicade. What sort of coercion can we expect from Obamacare ?
Your mumbling. The reason the doctor was stripped of his FAA certification is because he is irrevelant without Medicare/Medicade. Got it?
Maybe your “friend” should be a better doctor.
The real truth is, OBAMACARE IS IRREVELANT. The system is dead anyway you go about it.
Incorrect. Liberals don’t care if OBAMACARE works or if it doesn’t work. Simply don’t. Doesn’t change much nor will stop the implosion.
Get it straight.
If you say so..
Having been an active participant in helping my mother find independent living communities with A/L onsite as well, I can tell you there’s a big learing curve when it comes to how they are …set up? organized? financed? Her first one was run by, but not owned by, Marriott, and initially it was a great place. Nevertheless, as we heard it, it was later “sold”: Marriott left and Sunrise “took over.” And yet, if you had complaints, you’d find out that neither Marriott nor Sunrise was in charge. It was some partnership in Massachusetts. During her 7 years there, services declined and prices soared. (It was still a decent place, but new people were being charged at least 50% more)
When she moved to be closer to me, it was the same story again, including an obvious lack of funds for building maintenance and poor service. I doubt the Big Cost was employees – they worked long hours, had few days off, many could not afford cars and lived in over-crowded apartments.
Thoroughly discouraged, Mother struck out on another hunt and we discovered a non-profit continuing care facility at 60% the price, twice the living space, with attractive grounds and positive helpful people. Assisted Living, onsite for when she needs it, is sort of like a studio apartment with private bath, a patio, 3 meals a day… As you’ve no doubt seen, additional services are charged either hourly or on a “points” basis. The current cost for A/L is just under $3000/month, I believe. There was a “buy-in” but it was extremely reasonable compared to places built to look like luxury hotels and continuing care means they won’t throw her out if she runs out of money, even if she needs skilled care.
The point of all that is prices and services vary tremendously. Non-profits don’t advertise widely. We found this one by accident, just driving by. Maybe it’s unique? It was started with a religious affiliation, but is now accepting everyone. Probably due to a need for cash flow.
Once upon a time, the corporatized securitized places were seen as great investments, what with Boomers coming along, and all. It didn’t work out that way. Most Boomers don’t want them. Maybe that’s a function of having had to look into them for aging parents. Post-2008, I imagine the market has shrunk even more.
Thank you Mr. Beck
— Had to delete, to edit video link..
If you doubt that Obamacare is about creating a new, gigantic bureacracy, more than extending coverage to those without it.. The startup cost (ten years only) for Obamacare, is enough money to substantially subsidize private insurance for 30,000,000 people.. without creating an army of bureucrats to fund to infinity…
— 10,000,000 familes X $5,000 X 20yrs = $1T —
Of course subsidizing (or outright buying) private insurance with tax dollars is not the answer either.. the probelm is the cost.. not how we ultimately pay for it.
When asked about Obamacare, John Conyers openly admitted what conservatives have said all along: it’s a path to a single payer, socialized health care system. Those are words that liberals work so hard to never mention.
“Well it’s a platform. I don’t think they flow smoothly but without that, if we didn’t have this then health care, universal health care would be an even more difficult legislative objective.”
Thanks for having the intellectual honesty to publish something inconsistent with your preferences. This seems like a no-brainer basis for bipartisan cost cutting.
RweTHEREyet: “ our problems in health-care are the costs themselves; not how to pay them”
Right on! 🙂