In his first healthcare gambit of 1999, President Clinton last week proposed offering $1,000-a-year tax breaks to assist elderly or disabled people needing long-term care or family members who provide care informally.
Even Republicans seemed to like the move. But some long-term-care groups said it is a hollow political maneuver.
Financed through the elimination of tax loopholes, specified in Clinton's upcoming budget blueprint for fiscal 2000, the four-point plan will cost $6.2 billion over five years. It calls for creating a national network to support family caregivers through respite care and classes on caring for elderly and disabled people.
It also proposes a long-term-care insurance plan for federal employees and a $10 million campaign to educate seniors about the limitations of long-term-care coverage under Medicare.
Administration officials touted the flexibility that the tax credit will offer to the disabled and their families.
"We responded in a very practical way, to give support to the way long-term care is being provided in this country-for the most part, in people's homes, by caregivers who are related to them," HHS Secretary Donna Shalala said.
The proposal drew support on Capitol Hill, even among Republicans, who noted that it was similar to one they had included in a 1995 budget plan that Clinton vetoed.
The latest plan, and its support among the congressional GOP, reflects Clinton's strategy of more modest and targeted moves since the collapse of his comprehensive healthcare reform measure in 1994 (See story, p. 42).
Provider groups expressed support, at least for bringing the issue back to public attention. They said by using tax credits, Clinton is dodging a Capitol Hill budget battle over expanding entitlements.
But Clinton's proposal has some in the long-term-care industry grinding their teeth. They noted that since the budget reforms of 1997, HCFA has slashed Medicare payments for home health care and has narrowed its definition of patients who qualify for coverage.
"It's a fiasco, a slap in the face," said Jean Macdonald, director of government affairs for the Indiana Association for Home and Hospice Care. "A $1,000 rebate hardly meets the needs of the long-term patients (who) because of the adminstration's stance on the interim payment system no longer have access to Medicare home care."
Others said any tax-credit goal of keeping those with chronic healthcare needs out of institutions won't work.
Gayle Sasser, who heads the Tennessee Association for Home Care, said that a tax credit would be a welcome reward for those families already taking care of relatives in the home. But $1,000, she said, is not enough to persuade families who aren't doing so to begin taking care of a relative at home.