Peppering the CLASS Act's demise

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John O'Connor
John O'Connor
If there's one thing early January always delivers, it's a cornucopia of coming-year predictions. But as far as long-term care is concerned, it might be more helpful to look back to 1990.

The newly minted fiscal cliff deal helps explain why. The measure puts a final kibosh on the Community Living Assistance Services and Supports (CLASS) Act. But as compensation, it also sets up a wish-list panel for long-term care.

The group will consist of 15 White House appointed members, plus a sprinkling of House and Senate lawmakers. Its stated goal is to “develop a plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports.”

If that sounds vaguely familiar, it should. The panel has essentially been tasked with repeating the work conducted more than two decades ago by the U.S. Bipartisan Commission on Comprehensive Health Care.

Better known as the Pepper Commission (in honor of its chair, the late Claude Pepper), the blue ribbon panel offered up some interesting ways to improve long-term care. For example, it proposed that the federal government alone pay for the first three months of nursing home care. Federal and state governments would jointly pay for additional time, under that commission's plan. It also included provisions so Medicaid-covered residents could keep more of their assets.

Not that it mattered.

Rep. Pete Stark (D-CA) immediately pronounced the 1990 plan “dead on arrival.” He did so because the Pepper Commission never spelled out how money would be found to cover its upgrades. Turns out he was absolutely right. And for those of you keeping score at home, the first thing to look for when the new panel releases its plan later this year is how exactly it will be paid for. Don't be surprised if the math gets a bit hopeful, fuzzy or non-existent.

You need not be a graduate of the Eeyore School of Gloomy Pessimism to see that the next panel appears to be on a fool's errand. First, it is being pieced together at lightning speed (by Washington standards) at a time when intramural rancor in Congress has perhaps never been higher. The Department of Health and Human Services is not wed to the plan, which raises the question of who its champion will be. And on a related note, Congress is not even required to vote on the panel's recommendations. You've heard of administrators in training? This plan is a doorstop in training.

So if you are pining for a report that carefully lays out the challenges and possible solutions for long-term care, you'll be happy. But if you expect this to lead to legislative action, you may be sorely disappointed. As we've just seen, a divided Congress struggles to get anything done, even in crisis mode.

And long-term care isn't facing a crisis. Yet.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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