1. “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.

2. Aggregate Data on LTC Spending Year 1961197119811991200120062011 Total (bill.)$0.9$4.7$20.3$64.6$125.2$169.9$223.7 Change (%) from prior year3.911.514.912.46.55.44.4 Share of GDP (%)0.20.40.71.11.21.31.5 Home health share (%)6.64.114.523.527.531.033.2

3. Payment Sources for LTC Spending (Share of Total (%)) Year 1961197119811991200120062011 Out-of-pocket65.145.436.132.527.223.420.3 Private insurance0.20.43.59.711.68.87.8 Medicare03.75.810.218.625.631.4 Medicaid029.242.234.2 34.432.9 Other payers34.519.510.411.66.75.95.0

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

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

6. 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 )

7. 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?

8. Other Experience CBO scoring of CLASS SSDI

9. 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?