The challenge facing Congress in finding a long-term care compromise was illustrated at two Washington forums last week.
At separate hearings less than 24 hours apart, some members of Congress called for strong federal long-term-care quality standards while other members, backed by the General Accounting Office, argued that states should be get maximum flexibility to implement their own quality oversight systems.
The difficulty in fashioning a compromise that all sides can accept, and developing a way to pay for such a plan, could make long-term care a casualty of the congressional legislative process, advocates fear.
At a hearing of the Senate Labor and Human Resources subcommittee on aging, Chairwoman Barbara Mikulski (D-Md.) took the Clinton administration to task for not setting adequate federal standards of quality for long-term care in its healthcare reform plan.
"The president is asking (Congress) to pass a program that will eventually reach $56 billion (in outlays), and you say you will then set sophisticated federal standards?" Ms. Mikulski asked Robyn Stone, deputy assistant secretary of family, community and long-term-care policy for HHS.
When Ms. Stone answered that the standards purposely were left "mushy" because "states are already doing that," Ms. Mikulski shot back that Congress "can't spend $56 billion on mush."
Just one day after the attack by Ms. Mikulski, members of the Senate Aging Committee told Ms. Stone and Assistant Secretary for Aging Fernando Torres-Gil that states, which have oversight of long-term-care quality issues, must be allowed to continue their own programs.
The GAO, in a preview of a report to be released later this year, told the committee that Congress should pass a long-term-care plan that strives to allow "greater tailoring of services to the needs of the individual and greater flexibility in funding."
The House Ways and Means health subcommittee was unable to find a middle ground on long-term care and decided to pass the problem to the full committee. Long-term-care advocates say they're hopeful Congress can include it in its reform plan.
"We're trying to find a few members who are willing to say that long-term care has to be in the final bill or they won't vote for it," said Howard Bedlin, legislative representative for the American Association of Retired Persons.
But representatives of other advocacy groups privately said they're worried that long-term care will be left out for economic reasons.
Mr. Torres-Gil said the administration has its "own long-term-care agenda, and we are moving forward...to ensure that the infrastructure is in place."