The Idaho Business Review (Boise, ID)

January 30, 2006

SECTION: NEWS

LENGTH: 1183 words

HEADLINE: AmeriWell - Can it offset high health care costs?

BYLINE: Ken Miller

BODY:
A federal proposal to create long-term disability health care accounts for all Americans through innovative funding underscores the need to come to grips with a growing health care problem in Idaho, according to those who deal with disability and health care funding in the Gem State.

Financial planners say the proposed "AmeriWell" accounts to offset the rising cost of that care also shows the need to include long-term care among retirement and other personal financial plans.

Like the rest of the nation, Idaho is struggling to control soaring Medicaid and other health care costs. But Medicaid, the government health care assistance plan for lower-income Americans, and Medicare, the plan to help the elderly pay medical bills, don't help those facing catastrophic health costs of long-term care for disabilities.

The National Council on Disability (www.ncd.gov) issued a report to President Bush in December that outlined plans for the AmeriWell account that would be funded through such things as a one-cent-per-transaction fee on stock trades, tax-deductible savings and a new tax on wages.

The plan, still being explained to members of Congress and others in Washington, is designed to provide long-term health care that Medicare and Medicaid don't cover and to give Americans more freedom in selecting home-based or community-based health care services.

In announcing the AmeriWell proposal Dec. 15, NCD board member Carol Novak said the need for "long-term services and supports," or LTSS, is severe.

"Most Americans think of LTSS as long-term care for seniors with severe chronic disabilities who reside in nursing homes," Novak said. "Few Americans ever think of LTSS for individuals under the age of 65 with significant disabilities who are living and working in the community. Many people do not realize that there is no LTSS public policy for individuals of moderate to middle income whether over or under the age of 65."

Today, between 9 million and 12 million Americans need help with daily activities, and 3.5 million of them are under 65. Meanwhile, an estimated 25 million Americans 65 or under likely need LTSS assistance but fall through the cracks or are disqualified because of their income or their personal assets.

The AmeriWell program would provide LTSS coverage for all Americans regardless of age, with accounts created at birth.

Dr. Martin Gould of the NCD said AmeriWell is just one component of other reforms the Council is recommending. Others include such things as income tax deductions for those caring for disabled relatives.

"The AmeriWell approach is an effort to try to bring another perspective and an additional set of untapped resources to bear on a population of people who will be effected in a number of years," Gould said. "What you have is two demographic waves of the population who, combined, will tax the system that currently is really fragmented and ineffective in dealing with the needs they have.

"You can only tweak Medicare and Medicaid so far," he said. "But when people need nutrition, personal care, and transportation, what do you do? What are some of the creative options and ways communities are dealing with this? Some of them are doing very creative things, and some with government funding to fill the gaps."

"We decided we'd take the long-term service (issue) by the horn," Gould added, "and now we're just trying to share what we have found and all the different pieces to it."

Idaho Department of Health and Welfare spokesman Ross Mason said the agency, along with Gov. Dirk Kempthorne, continue to roll out new reform ideas to control the state's high runaway Medicaid costs. Mason said AmeriWell is one of many ideas worth exploring to find a way to finance long-term care for the disabled.

"The AmeriWell proposal is certainly an interesting idea," Mason said. "Long-term care is very important in Idaho. It's also very expensive in Idaho. The state and the federal government are going to be open to any solutions."

With Medicaid costs commanding an ever-larger part of Idaho's budget, Mason said, "Idaho and anybody else is going to be willing to listen to those ideas. We're looking at long-term care, no question about it. It's got to be part of the solution. People have made it very clear they'd prefer to receive the long-term care at their home when possible rather than in an institution. Whatever we can do to encourage that … we're certainly willing to do that."

Kelly Buckland, executive director of the Idaho State Independent Living Council (www2.state.id.us/silc) and the current president of the National Council on Independent Living, said the AmeriWell plan is aimed at the same health care concerns as the proposed Community Living Assistance Support and Services Act, or "CLASS Act."

"It does much the same thing," Buckland said, adding that such measures to provide long-term care for all disabled people is long overdue.

"It acts more like what Social Security and Medicare do," he said. "It would be an account, funded by you and your employers, who both pay into this account. Then, if you had a need for long-term care, you would be able to go into that account."

"NCD's not the only one talking about this," Buckland noted. "The whole concept of funding long-term accounts is getting a lot of traction. But we still need to have some discussions on how to do it best."

Buckland said "there is some discomfort" about a proposal that would create a "whole new bureaucracy" when some existing programs can be changed to deliver services to those not currently receiving them.

He also said long-term care isn't just a concern for the elderly disabled.

"It isn't about age; it's about disability," he said. "Long-term care is either the second or third-largest program in Medicaid. If you want to address the cost of Medicaid, you've got to address the cost of long-term care."

Jim Baugh, executive director at Comprehensive Advocacy in Boise, said any plan that encourages home care for long-term disabilities over institutional care can both save huge amounts of money and offer a better quality of life for those who don't need to be in hospitals or other institutions.

"We're always concerned about how we build a long-term care system," Baugh said. "The reliance in the past on a purely institutional model has created a very expensive and not necessarily responsive system that's not particularly good for the people who use it. For many people who don't prefer that (home-based, long-term care), it's because no one has stretched the envelope on what can be done in their home."

Innovations such as AmeriWell and other long-term care plans will help Idahoans remain at home, Baugh said, and save the state money as well.

"It's almost universally recognized that supporting people in their own homes is a lot cheaper than supporting quality institutional care," he said. "Even when it becomes very costly supporting people in their own homes, it's still cheaper than supporting people in institutional settings. And it allows people to keep their community contacts. Those contacts are important to people's quality of life."