The Congressional Commission on Long-Term Care convened for its third hearing last week, focusing on how Medicare, Medicaid and long-term care insurance interact, and potential ways to strengthen these payment mechanisms.

Over roughly eight hours, the 15 commission members heard from a total of 15 subject matter experts on four separate panels. The volume and complexity of the testimony underscored the commission’s challenge: to deliver a report to Congress by the end of September, recommending how the nation’s long-term care system might be reformed from the perspective of both health outcomes and cost efficiency.  

Commission members and observers have argued for an extension of the September deadline, noting delays in convening the full 15-member panel.

Given its difficult mission and the compressed timeline, it would be “miraculous” if the commission comes up with “useful solutions,” wrote Joel Hay, Ph.D., in an Orange County Register column last week. Hay is a professor at the University of Southern California Schaeffer Center for Health Policy and Economics.

Hay also noted that Congress might “simply ignore” the commission’s report.

Commission member Grace Marie Turner may have had this in mind at the Aug. 1 hearing, as she sought recommendations that could realistically lead to Congressional action. Turner, president of public policy research organization the Galen Institute, asked how Congress might be convinced to make an “upfront investment” in transforming Medicare and Medicaid into a more “flexible system” that would better support long-term care.

Congress has been willing to approve demonstration projects to test more coordinated healthcare delivery and payment systems, responded panelist Diane Rowland, Sc.D. However, the variety of demonstrations may have created “too many different buckets to try to tap and too much time spent on waivers,” when a more “wholesale revision” may be needed, she said. Rowland is executive vice president of the Henry J. Kaiser Family Foundation and executive director of the Kaiser Commission on Medicaid and the Uninsured.

The commissioners left the hearing with thumb drives containing all the public input that has been received so far. Commission Chairman Bruce Chernof, M.D., renewed the call for comments and assured the public that all comments will be read.

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