Tower of Babel

It is interesting to watch the different reactions to the passage of the Federal Health Care Reform Law in the long-term care industry. Like the Tower of Babel, everyone is weighing in on every aspect of the bill before the dust has settled. It seems to me that a bill more than 1,000 pages long, even zeroing in on only those parts of it that affect one’s specific industry, would need a little more study than a “shoot from the hip” response.

I think Bruce Chernof, MD, president and CEO of the SCAN Foundation, possibly has hit upon one of the best ways of looking at the bill: “The key thing to realize is the health care reform bill actually has probably a couple of dozen opportunities, all told, to think differently about aging successfully.” That, unarguably, is positive. There is a flip side to this statement, though, for some administrators. When formulating the bill, did our legislators think about how the American people can age successfully through its mandates that have now become law?

Some administrators have told me they are worried about:

• A 2.3% tax on wheelchairs and other medical supplies and a reported $27 billion medicine cabinet tax on drugs.

• The Congressional Budget Office predicts 15 million new people will be added to Medicaid which is increasingly rationed and where provider choice will be increasingly restricted.

• The home medical equipment sector was subjected to a 9.5% decrease in reimbursements effective January 1, 2009. More cuts are projected in facilities’ revenues because of Medicare cuts.

• For many CCRCs that don’t rely as much on government-reimbursed services, concern for the new bill is focused on employer-required health benefits. For instance, employers will be required to cover employees’ dependent children up to age 26. Many organizations that are currently self-insured for healthcare expenses may be forced into more expensive commercial insurance products that will increase their financial burden.

• Administrators have read at least 15% of hospitals, nursing homes, and other healthcare organizations will fail or be acquired.

Even the London Daily Telegraph (March 22, 2010) weighed in with the statement: “It [bill passage] is also a great leap forward by the United States towards a European-style vision of universal health care, which will only lead to soaring costs, higher taxes, and a surge in red tape for small businesses.”

Most of the administrators I talked to were against the bill as the preceding concerns show. I wish I was smart enough to be able to predict how this bill would affect long-term care, but I’m not. No one is. This is going to be a slow dance that unfolds with new steps added as we go; some will be graceful moves, others toe-crunchers. One thing I can promise: Long-Term Living will bring you thoughtful analysis and insight on how the bill will affect you. The coverage starts in this issue with our cover story by noted policy analyst Vincent Mor, PhD, MEd, of Brown University. We will bring you more coverage in subsequent issues to help guide you through the maze of this history-making bill. Knowledge is power. Please send me your comments, concerns, and areas you’d like to see us cover in Long-Term Living.

Maureen Hrehocik, Editor Long-Term Living 2010 May;59(5):8