One of the many wild cards in the administration's healthcare reform plan is the $80 billion long-term-care benefit, which some experts predict will be stripped or scaled back in whatever bill Congress ultimately approves.
It is "the single most vulnerable piece" of the president's plan, said Joshua Wiener, a senior fellow at the Brookings Institution who specializes in long-term care and is a former member of the White House task force that developed the reform plan.
Although public opinion polls show that support for healthcare reform is stronger when long-term care is included in the benefits, such a program isn't "logically central" to the basic goal of providing acute and primary care for all Americans and controlling costs, Mr. Wiener said.
"Long-term care is politically unique in that it's a new benefit you can provide to almost everyone," he said. Nevertheless, it's not "intellectually central to managed competition," which is the framework for President Clinton's vision of a restructured healthcare finance and delivery system, he said.
Furthermore, the financing for a long-term-care benefit is threatened by weak support from both ends of the political spectrum, Mr. Wiener said. Liberal democrats-such as Reps. Henry Waxman (D-Calif.), chairman of the Energy and Commerce subcommittee on health and the environment, and Fortney "Pete" Stark (D-Calif.), chairman of the House Ways and Means health subcommittee-oppose the hefty $124 billion in Medicare cuts, part of which would be used to pay for the program.
Conservative members, meanwhile, believe that if such deep spending reductions can be achieved, the savings should be used for deficit reduction as opposed to adding a new government benefit, Mr. Wiener said.
Paul Willging, executive vice president of the American Health Care Association, which represents more than 12,000 long-term-care providers, agreed that the benefit was vulnerable, "because regardless of how it is described by the administration, let's face it, it is an entitlement."
He said the program would have a better chance in Congress if beneficiaries had to meet certain income standards to qualify. But powerful senior-citizen groups, including the American Association of Retired Persons and Families USA, have long opposed such requirements for Medicare benefits.
Scott Parkin, director of communications for the American Association of Homes for the Aging, said his organization has been assured by the Clinton administration that "they are not going to broker away the home- and community-based care" portions of the reform plan.
"But realistically, with moderate and conservative Democrats and Republicans saying, `Don't add new benefits,' it is going to be a tough fight," he said.-Lynn Wagner and Eric Weissenstein