Call it the case of the disappearing long-term-care benefit.
As the healthcare reform proposals before Congress have been scaled back, the plans' long-term-care provisions have shrunk to the point where the support of long-term-care groups and advocates for seniors, once thought to be a sure thing, is now in jeopardy.
Although polls have shown that public support for healthcare reform increases significantly when long-term-care benefits are included, sponsors of healthcare legislation have reduced such benefits as they attempt to keep reform alive in the waning weeks of Congress.
The latest Senate plan, unveiled by a bipartisan group led by Sens. John Chafee (R-R.I.) and John Breaux (D-La.), has deficit reduction as its chief focus, further reducing the chances that costly new benefits can be included.
Provider groups and elder advocates said they were concerned from the start that the cost of long-term care would make it an easy target of budget-cutters.
"We always knew it was going to be a costly benefit," said Barbara Gay, congressional affairs director for the American Association of Homes and Services for the Aging, which represents long-term-care facilities. "We were always aware of the problem with cost."
In paring long-term-care benefits, healthcare reform sponsors run the risk of losing the support of key constituencies, most notably retiree groups and disabled-elder advocates. Such a loss of support could be the final blow to a reform cause that does not need any more enemies.
In 1992, the nation's long-term-care spending totaled $62 billion, according to the Health Insurance Association of America.
What brings the concerns of long-term-care groups in sync with other provider groups is shared worry over the level of Medicare spending reductions included in the incremental reform plans before Congress.
For example, the so-called mainstream proposal fashioned by Sens. Chafee and Breaux includes $263 billion in Medicare cuts and $120 billion in Medicaid reductions over 10 years.
With only a minimal long-term-care provision to sweeten the pot, the elderly have little reason to support that version of healthcare reform, said Joshua Wiener, senior fellow with the Brookings Institution.
"If you continue to have significant Medicare cuts, you've got to somehow or other tell the elderly that they're not going to be worse off," Mr. Wiener said.
If Medicare is cut without providing the elderly a long-term-care benefit, "I think you could easily build an argument that they're going to be worse off," he said.
"We have expressed our strong concern about the mainstream bill because what we're talking about is so minuscule and is means-tested," said Stephen McConnell, chairman of the Long Term Care Campaign, a coalition of 140 national groups. "You worry if (the money) will be eaten up in assessments and putting a bureaucratic structure in place."
Despite the dismal prospects for a bigger long-term-care benefit, Ms. Gay said her group supports preserving some long-term-care provisions, primarily reforming the long-term-care insurance market to make insurance more affordable and accessible.
"The fact that long-term care is part of the mainstream bill at all is very encouraging," she said. "It's something that we would hope to build on in the next Congress."
That sliver of optimism was not shared by John Rother, director of legislation and public policy at the American Association of Retired Persons, who said the long-term-care provision in the mainstream plan "doesn't even pass the laugh test.
"It is so far away from being adequate that there is no way we could support it," Mr. Rother said.