Long-term care legislation: an issue of concern for nurse practitioners.
Comprehensive long-term care policy has many hurdles to overcome before it becomes a reality. The biggest hurdle is the price tag! Estimates range from $6 billion (Pepper's home-care bill) to $46 billion (Stark's long-term care coverage bill). Congressional insiders predict that federal long-term care coverage must contain "pay-as-you-go" financing to win congressional passage. The medicare catastrophic health care act is cited by many in the Congress as establishing the precedent for self-financing of new federal benefits. In a pay-as-you-go era in public spending, any new program can only come from trimming existing programs and shifting those funds to new programs or from generating new revenues. The latter could result from increased beneficiary cost-sharing, an increase in the medicare payroll tax, or by eliminating the $45,000 cap on income exposed to the current 1.45% medicare payroll tax. Federal proposals to date build on existing medicare and medicaid programs. In them, quality assurance measures have been strengthened, consumer input encouraged, and a new layer of bureaucracy established to screen potential clients and provide case-management services. The scope of services is broad in most of the current proposals, and reimbursement is provided for respite care to allow family care givers relief and assistance. Access to nurse practitioners' services is an important feature of Kennedy's Lifecare proposal and is the focus of lobbying efforts for all public and private proposals. It is time for nurse practitioners to become involved in long-term care legislation. This may be initiated by reviewing current proposals and long-term care packages offered by major insurance companies. Any future long-term care benefit should bear the imprint of the nurse practitioner's professional perspective and the profession's commitment to humane, caring health policy.