[Congressional Record Volume 146, Number 99 (Wednesday, July 26, 2000)]
[Senate]
[Pages S7674-S7676]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRAHAM (for himself, Mr. Grassley, Ms. Mikulski, Mr. Bayh, 
        Mr. Breaux, Ms. Collins, and Mr. Akaka):
  S. 2935. A bill to amend the Employee Retirement Income Security Act 
of 1974, the Internal Revenue Code of 1986, and the Public Health 
Service Act to increase Americans' access to long term health care, and 
for other purposes; to the Committee on Finance.


                 the omnibus long-term care act of 2000

  Mr. GRAHAM. Mr. President, it is with great pleasure that I rise 
today to introduce the Omnibus Long-term Care Act of 2000 with my 
colleagues Senators Grassley, Mikulski, Bayh, Breaux, Collins, and 
Akaka.
  Americans in need of long-term care now face a fragmented and 
inadequate system of state and federal programs. This is no longer 
acceptable. Millions are struggling today to meet their long-term care 
needs, and these numbers will grow dramatically as the country ages. 
While Medicare reform is important, we will have accomplished little if 
we address seniors' acute care needs, but then leave them to suffer in 
poverty when they require long-term care.
  I am pleased to introduce bipartisan legislation that demonstrates 
the Senate's commitment to addressing this issue in a comprehensive 
way. The Omnibus Long-term Care Act of 2000 will

[[Page S7675]]

help millions of seniors and their caregivers who are struggling in our 
communities, while also encouraging all Americans to better plan for 
their own retirements.
  Many seniors move to Florida with plans of a comfortable retirement, 
but all too often, these hopes are never realized. A stroke or 
Alzheimer's Disease strikes and a family is quickly overwhelmed by 
their long-term care costs and responsibilities. To complicate matters, 
many spouses of disabled seniors are frail themselves, and so find it 
increasingly difficult to meet the needs of their loved ones.
  Caregiving is also a huge concern for the millions of Americans in 
the sandwich generation, those who are caring both for their children 
and their parents, while also balancing work obligations. Almost one-
third of all caregivers is juggling employment and caregiver 
responsibilities, and of this group, two-thirds have conflicts that 
require them to quit work, cut hours, or turn down promotions.
  It is clear that too many Americans are now being forced to sacrifice 
their health and their careers to care for their loved ones. To help, 
this bill: provides the disabled or their caregivers with a $3,000 
long-term care tax credit; implements the National Family Caregiver 
Support Program, which will provide caregivers with information and 
services to help them meet their responsibilities; increases Social 
Services Block Grant funding for community-based long-term care 
services; and ensures that seniors can return to their nursing home 
after hospitalization.
  This bill can also avert the long-term care crisis that will result 
if we do nothing to prepare for the aging of the Baby Boomers. Millions 
who are struggling to care for their parents today will soon need long-
term care themselves. Baby Boomers had a higher divorce rate and fewer 
children than today's seniors, so they will not have the same support 
network that today's retirees enjoy.
  With more seniors needing more paid help in the future, costs will 
skyrocket. According to the Congressional Budget Office, individual 
out-of-pocket costs for long-term care could nearly double from $43 
billion today to $82 billion in 2020, and government's costs could 
increase from $73 billion to $125 billion in the same period. It is 
clear that future retirees and the government cannot afford business as 
usual.
  We must ask all Americans to take more responsibility for their own 
long-term care needs. To help bring this about, this bill: offers a tax 
deduction for the premiums of long-term care insurance policies; 
provides long-term care insurance to federal employees; authorizes a 
national public information campaign to educate employers and employees 
about the benefits of long-term care coverage; mandates a federal 
survey to determine whether cities and counties are ``elder-ready;'' 
calls for studies to determine how best to meet Americans' future long-
term care needs; and includes a Sense of the Senate affirming the 
body's commitment to ensuring seniors' physical, emotional, and 
financial well-being in the new century.
  The long-term care crisis we face demonstrates that we have neglected 
this issue for far too long. But we must act now. The large number of 
seniors and their caregivers who are suffering in our communities today 
and the future needs of the Baby Boomers require it. A big problem 
requires a big solution, and this bill helps protect seniors today and 
in the future.
  All of the cosponsors of this legislation have championed the need to 
meet seniors' long-term care needs. The fact that we have all come 
together in a bipartisan manner demonstrates that the Senate is 
committed to addressing this issue in a meaningful way. I look forward 
to working with my colleagues and the many organizations that support 
this bill to make comprehensive long-term care reform a reality.
  Ms. MIKULSKI. Mr. President I rise as a proud original cosponsor of 
the Omnibus Long-Term Care Act of 2000. I am very pleased to join 
Senators Graham, Grassley, Bayh, Collins, Breaux, and Akaka to 
introduce this bipartisan legislation that provides a comprehensive 
approach to the long-term care of our nation's citizens. I am committed 
to finding long-term solutions to the long-term care problem in our 
country.
  I like this bill because it meets the day-to-day needs of Marylanders 
and the long-range needs of our country. At least 5.8 million Americans 
aged 65 and older currently need long-term care. While this legislation 
has many important provisions, I would like to highlight three of its 
features: the National Family Caregiver Support Program, long-term car 
insurance for federal employees, and the ``return to home'' provision.
  First, this bill would establish the National Family Caregiver 
Support Program. I am proud to have sponsored and cosponsored this 
legislation previously in this Congress. This program will provide 
respite care, training, counseling, support services, information and 
assistance to some of the millions of Americans who care for older 
individuals and adult children with disabilities. In fact, eighty 
percent of all long-term care services are provided by family and 
friends. This program has strong bipartisan support, will get behind 
our nation's families, and give help to those who practice self-help.
  As Ranking Member of the Subcommittee on Aging, I am pleased to 
report that last week the Health, Education, Labor, and Pensions 
Committee unanimously approved a bipartisan bill to reauthorize the 
Older Americans Act (OAA). This bill included the caregiver support 
program which is strongly supported by the entire aging community. As I 
work with Senators Jeffords, Kennedy, and DeWine and our colleagues in 
the House to pass the OAA reauthorization in September, I want to 
strongly urge fellow appropriators in the House and Senate to fund 
these vital caregiver support services as close as possible to the full 
funding level of $125 million. Millions of Americans are waiting for 
Congress to act.
  Second, I think it is important that this bill includes the Long-Term 
Care Security Act. This bill would enable federal and military workers, 
retirees, and their families to purchase long-term care insurance at 
group rates (projected to be 15-20 percent below the private market). 
It would create a model that private employers can use to establish 
their own long-term care insurance programs. As our nation's largest 
employer, the federal government can be a model for employers around 
the country whose workforce will be facing the same long-term care 
needs. Starting with the nation's largest employer also raises 
awareness and education about long-term care options.
  Yesterday, the Senate passed the Long-Term Care Security Act (H.R. 
4040). I am proud to be the lead Democratic sponsor of the Senate 
companion to this bill, S. 2420, because it gives people choices, 
flexibility, and security. Families will have an additional option 
available to them as they look at their long-term care choices. This 
provision would also help reduce reliance on federal programs, like 
Medicaid, so the American taxpayer benefits.
  This legislation also provides people with flexibility because it 
allows them to receive care in different types of settings. They may 
choose to be cared for in the home by a family caregiver--or they may 
need a higher level of care that nursing homes and home health care 
services provide. Different plan reimbursement options will ensure 
maximum flexibility that meet the unique health care needs of the 
beneficiary.
  Long-term care insurance also provides families with some security. 
Family members will not be burdened by trying to figure out how to 
finance health care needs--and beneficiaries will be able to make 
informed decisions about their future.
  Finally, I am pleased that the bill we have introduced includes 
bipartisan legislation that I have previously sponsored, the Seniors' 
Access to Continuing Care Act (S. 1142). This legislation protects 
seniors' access to treatment in the setting of their choice and ensures 
that seniors who reside in continuing care communities, and nursing and 
other facilities have the right to return to that facility after a 
hospitalization, even if the insurer does not have a contract with the 
resident's facility.
  Across the country seniors in managed care plans have discovered too 
late that after a hospital stay, they may be forced to return to a 
facility in the plan's provider network and not to the continuing care 
retirement community or skilled nursing facility

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where they live. No senior should have to face this problem. In 
Maryland alone, there are over 12,000 residents in 40 continuing care 
retirement communities and 24,000 residents in over 200 licensed 
nursing facilities. I have visited many of these facilities and heard 
from residents and operators about this serious and unexpected problem.
  Residents choose and pay for facilities like continuing care 
retirement communities (CCRC's) for the continuum of care, safety, 
security, and peace of mind. Hospitalization is traumatic. Friends, 
family, and familiar staff and faces are crucial to a speedy recovery. 
Where you return after a hospital stay should be based on humanity and 
choice, not the managed care company's bottom line.
  Specifically, the Seniors' Access to Continuing Care Act protects 
residents of CCRC's and nursing facilities by: enabling them to return 
to their facility after a hospitalization; and requiring the resident's 
insurer or managed care organization (MCO) to cover the cost of the 
care, even if the insurer does not have a contract with the resident's 
facility. Certain conditions must be met.
  This legislation also requires an insurer or MCO to pay for a service 
to one of its beneficiaries, without a prior hospital stay, if the 
service is necessary to prevent a hospitalization of the beneficiary 
and the service is provided as an additional benefit. Lastly, the bill 
requires an insurer or MCO to provide coverage to a beneficiary for 
services provided at a facility in which the beneficiary's spouse 
already resides, even if the facility is not under contract with the 
MCO. Certain requirements must be met. These provisions are an 
important part of our safety net for seniors.
  I want to salute the strong leadership of the other cosponsors of 
this legislation who have authored various provisions of this 
comprehensive bill that we have joined together to introduce today. I 
know that all the cosponsors are sincerely committed, as I am, to 
addressing the challenges facing our aging population. I look forward 
to working with all of them to enact this important legislation.
  Mr. AKAKA. Mr. President, it is with great pleasure that I cosponsor 
the Omnibus Long-term Care Act of 2000, introduced by Senator Graham. 
The cosponsors of this legislation are well-known for their commitment 
to encouraging all Americans to prepare for their own long-term needs.
  Many Americans mistakenly believe that Medicare and their regular 
health insurance programs will pay for long-term care. They do not. 
Although Medicare provides some long-term care support, an individual 
generally must ``spend-down'' his or her income and assets to qualify 
for coverage.
  More and more Americans are requiring long-term care. About 6.4 
million Americans, aged 65 or older, require some long-term care due to 
illness or disability. Over five million children and adults under the 
age of 65 also require long-term care because of health conditions from 
birth or a chronic illness developed later in life. Only 12 percent 
receive care in nursing homes or other institutional settings.
  The need for long-term care is great. In 20 years, one in six 
Americans will be age 65 or older. By the year 2040, the number of 
Americans age 85 years or older will more than triple to over 12 
million. The cost of nursing home care now exceeds $40,000 per a year 
in most parts of the country, and home care visits for nursing or 
physical therapy runs about $100 per visit. In 1996, over $107 billion 
was spent on nursing homes and home health care. However, this figure 
does not take into account that over 80 percent of all long-term care 
services are provided by family and friends.
  In my own state of Hawaii, 13.2 percent of the population is 65 years 
and older. Although Hawaii enjoys one of the highest life 
expectancies--79 years, compared to a national average of 75 years--the 
state's rapidly aging population will greatly impact available 
resources for long-term care, both institutional and from non-
institutional sources. Hawaii's long-term care facilities are operating 
at full capacity. According to the Hawaii State Department of Health, 
the average occupancy rate peaked at 97.8 percent in 1994. But 
occupancy remains high. By 1997, the average occupancy dropped to 90 
percent.
  These statistics point to the overriding need to help American 
families provide dignified and appropriate care to their parents and 
relatives. We know that the demand for long-term care will increase 
with each passing year, and that federal, state, and local resources 
cannot cover the expected costs. Nursing home costs are expected to 
reach $97,000 by the year 2030.
  What Congress can do, however, it make long-term care insurance 
available to a broad segment of the population. As the ranking minority 
member of the Subcommittee on Federal Services, I co-chaired a hearing 
on long-term care insurance on May 16, 2000. We heard testimony on S. 
2420, legislation to authorize the Office of Personnel Management to 
contract with one or more insurance carriers for long-term care 
insurance for federal and military personnel and their families. As a 
cosponsor of that bill, I am pleased that just last night, the Senate 
passed our measure after substituting the text of S. 2420 under H.R. 
4040, the House long-term care bill for the federal family. The bill, 
as amended, also includes provisions of S. 1232, the Federal Erroneous 
Retirement Coverage Corrections Act, which I cosponsored with Senator 
Cochran last year. These provisions will provide relief to the 
estimated 20,000 federal employees who, through no fault of their own, 
found themselves in the wrong retirement system. H.R. 4040, as amended, 
offer a model for the private sector. I am delighted that similar 
legislation providing long-term care insurance for federal employees 
and military personnel is included in Senator Graham's bill, and I 
welcome the opportunity to join with him in helping Americans meet 
their long-term care needs in a dignified manner.
  The bill introduced today provides a comprehensive effort to address 
our citizens' long-term care needs. Among its provisions are the 
authorization of a phased-in tax deduction for the premiums of 
qualified long-term care insurance, implementation of the National 
Family Caregiver Support Program, restoration of $2.38 billion 
authorization for the Social Services Block Grant, and creation of a 
national public information campaign.
  Mr. President, I am pleased to be an original sponsor of this bill.
                                 ______