“Questions for the New Federal Commission on Long-term Care” By Mark J. Warshawsky Commission Member May 23, 2013 LTC Discussion Group Washington, D.C.

Aggregate Data on LTC Spending Year Total (bill.)$0.9$4.7$20.3$64.6$125.2$169.9$223.7 Change (%) from prior year Share of GDP (%) Home health share (%)

Payment Sources for LTC Spending (Share of Total (%)) Year Out-of-pocket Private insurance Medicare Medicaid Other payers

Questions What caused rapid increase? – demographics? – social insurance programs? Future Growth? – near-term – long-term – Trustees’ conceptual framework

Questions Home Health Care – up-coding, fraud? – replace “expensive” nursing home care? – Managed Medicaid effect? Private Insurance – LTCI? – other

Studies on the Interaction of Public and Private Insurance Brown and Finkelstein Federal Reserve of Chicago economists Knowledge Surveys Murtaugh, Spillman and Warshawsky (Brown and Warshawsky )

Questions Empirical evidence for Brown and Finkelstein? Medicaid planning – asset shifting? – state enforcement? Lack of longevity insurance? Lack of knowledge? Partnership LTCI effect LTCI market conditions and experience Combination policies better? Medicaid carve-out for life care annuity?

Other Experience CBO scoring of CLASS SSDI

Questions Other sources of government expertise on scoring and analysis? SSDI worrisome pattern? Reform the commission? – time horizon – consensus – staff Separate out consideration of different populations?