Long-term care insurance bill. (column)

On April 21, Senator George J. Mitchell (D-ME) introduced Senate bill 2305, providing for long-term care insurance. His plan would cover nursing homes, home-health care, even respite care. His cost estimate: $16 to 18 billion by fiscal l993. The Senate Finance Committee's Subcommittee on Health, chaired by Mitchell, held hearings in June, at which many long-term care organizations supported the bill - the American Association of Retired Persons, the American Health Care Association, and others.

"We as a nation donot have a lo ngterm care policy," Mitchell pointed out. His bill would provide a new Medicare benefit but, he said, with the least restrictiveness and most cost-effectiveness possible.

Under Mitchell's bill, Medicarewould reimburse those who qualify for chronic nursing home care after a two-year exclusionary period. During it, beneficiaries would rely on long-term care insurance, reverse home-equity mortgages, or themselves. The bill seeks to encourage development of private insurance to assist in the interim.

Reimbursement would be unlimited, but a 30% copayment for services would be required. Medicaid would cover people who could not support themselves during the exclusionary period, or who could not meet the 30% copayment requirement. Not affected or subject to the exclusionary period would be current Medicare skilled-nursingfacility benefits.

Eligibility criteria would include functional impairment (in two or more activities of daily living) and cognitive dysfunction. The secretary of Health and Human Services would develop assessment and certification processes. Criteria for nursing home subsidy would be "no more restrictive than the criteria currently specified by Medicaid for the intermediate level of nursing home care ' Case-management services would be contracted for.

Mitchell wrestled with the dilemma of whether to support long-term or short-term nursing home residency. Together they would not be affordable. Although he opted for the exclusionary period, the former, he sought to whittle it down as much as financially possible.

"Decreasing the exclusionary period dramatically increases the cost;' he noted. By fiscal l993, he calculated, the difference between a twoyear and a one-year would be over $10 billion (and sponsors have been known to underestimate the cost of their bills). Longing for the one-year, he settled for the two-year because of fiscal effect and anticipated insurer reaction.