Under the glare of television lights, four governors recently kicked off what they hope will be at least a year-long conversation about long-term health care for the elderly.
The forum, entitled "A lifetime of health and dignity Confronting long-term care challenges in America," started airing last week on public television affiliates around the country. Idaho Gov. Dirk Kempthorne (R) will host three subsequent forums on long-term care in the coming year.
Kempthorne, chair of the National Governors Association, was joined by Hawaii Gov. Linda Lingle (R), Georgia Gov. Sonny Perdue (R), Tennessee Gov. Phil Bredesen (D), former U.S. House Speaker Newt Gingrich and former White House Budget Director Alice Rivlin. The roundtable talk was moderated by Morton Kondracke, editor of the Capitol Hill newspaper Roll Call.
With a new Medicare program signed into law just this month, health care for older Americans is certainly not a new concern for policy makers, but looming now is the impending retirement of the World War II Baby Boomers. In 2008, nearly 77 million Americans will start to turn 65 years old and already cash-strapped states and public health safety-net programs such as Medicaid will not be able to keep up, the governors said.
"Every state has concerns about the cost of long-term care and what's going to happen when the Baby Boomers come along," Tennessee's Bredesen, a former health management businessman, told Stateline.org.
Medicaid expenditures account for more than 20 percent of state budgets. The most expensive part of the state-federal program for the poor and disabled, per person, is long-term care, often nursing home care. Many states facing budget deficits cut, froze or provided very small increases for nursing home reimbursement rates in 2003, according to the National Conference of State Legislatures.
Kempthorne said that despite tight budgets and empty pockets, states and individuals need to invest in their future health care because in the long-run "there's a return on investment."
The average American will have saved about $30,000 for their retirement, but the average cost for one year in a nursing home is more than $50,000 and the average stay more than two years, according to the NGA.
"There are currently successful programs for young couples to begin investing in their children's education," Kempthorne told Stateline.org in an interview. "I contend that once they make the final installment in that, they should make their first installment in long-term care for themselves."
Georgia's Perdue said it was important to subsidize community programs that help senior citizens live on their own because it is 10 times less expensive for states to pay for these programs than for nursing home bills.
"We think in Georgia it's a good investment" to pay for programs that allow seniors to stay in their home as long as possible, Perdue said.
Kempthorne and Perdue, both Republicans, also said states should examine tax incentives at the state level to encourage Americans to save for their long-term health care.
However, saving for the future isn't an option for everyone, Rivlin, a former Clinton administration official, said.
"There are a large number of people in the United States and will be for some years to come who don't earn very much, who live close to the edge, often in debt, and for whom savings, even with some kind of tax incentive, is not realistic," Rivlin said.
Kempthorne, whose mother suffered a stroke and is in her late 80s and depends on her husband as a caregiver, said it was also important not to "get stuck on the statistics" of the issue.
"Those times (my father) cannot have a caregiver in the home, on the weekends when it is the two of them, it is extremely difficult for them. So this is an issue that is far-reaching, it touches humanity," he said.
To raise awareness and jump start state-level initiatives, Kempthorne assigned a bi-partisan group of 10 governors the task of studying long-term care over the next year and writing papers or recommendations for best practices in different areas including: financial planning, disease prevention, disease management, building community-based care and implementing new technology.
Kempthorne told Stateline.org he wants states to investigate using technologies such as bar coding, tele-medicine and electronic prescribing to reduce medical errors and save time and money.
"What I hope is that long-term care and long-term living is an issue that governors are conversing in, understand the ramifications and implications of and that a year from January, you start to see governors address this in their respective states," Kempthorne said.