Support to perform the routine activities of daily living and to maintain their quality of life and their independence if possible. I appreciate you calling this hearing to try to improve our current long term financing and Delivery System. As the senate cochair of the Bipartisan Congressional Task disease, izheimers am particularly concerned and sensitive to the needs of alzheimers patients and their i particularly look forward to discussing ways to more support to the 62 million Family Caregivers who in 2009 provided an estimated 450 billion in uncompensated Long Term Care, more than double the value of all paid longterm care. Majorerm care is the Catastrophic Health care expense faced by americans today in these will only increase as our nation ages. Its not just that there will be a greater number of americans, it is also that Older Americans are living longer. Are ours 85 and older socalled oldest old. They are the fastestgrowing segment of our population. This is the very population most of the multiple and in directing Health Problems that can lead to disability and a need for longterm care. At the same time, declining birth rates mean therell be fewer family members and caregivers to care for our. Today, theretion are approximately seven potential caregivers for each person over 80 as this chart indicates. By the year 2030, there will be only four. By 2050, the number drops to fewer than one in three. Fewer than three. Peoplensequence, more will have to rely on fewer caregivers. What does that mean . What are the implications for the quality of care that we will be given . Is clear we have to do more to support Family Caregivers and recruit and retain a robust and confident competent longterm care workforce. While there is the need for both public and private financing of Longterm Services and support, i do believe we must do more to encourage americans to provide for their own longterm care needs. Many mistakenly believe that medicare or their private medical insurance policies will cover the cost of longterm care should they develop a chronic illness or Cognitive Impairment like alzheimers. Unfortunately, far too many do not discover they simply dont have coverage until they are confronted with the ethical placing a frail parent or loved one in a Long Term Care facility and face the shocking realization that they will have to bear the cost themselves. Consider theird future longterm care needs just as they plan for their retirement or purchase Life Insurance to protect their families. Private lending for longterm will not only provide families with greater Financial Security but also will ease the growing financial burden on the Medicaid Programs and strengthening the ability of that program to serve as a Long Term Care safety net for those americans most in need. Again, mr. Chairman, thank you for calling this hearing and i look forward to hearing from our witnesses. Out of the spirit of and assistance, i would extend to our most distinguished Committee Say as the opportunity to word or two before we turn to our witnesses. Let me say that i appreciate mr. Chairman, you holding this hearing because it is such an important issue. I come before you as a son, grandson and former governor that out with these matters through personally. Is not al you there greater thing we can do to add dignity and respect to a persons life as they grow older than try to have them live an independent lifestyle. I will give you one story. My grandmother was 85 years of age and i would see her all the time. One time i stopped and she was very lethargic and just sitting there. She said every thing is ok and i could tell something was wrong. I told my mom and said go see grandma again because my mother always wanted to live with us and be independent. This one time my mother went to be with her. Then she stayed for 15 more years and lived to 100 years of age. The thing about it was it she was lonely. Poor nutrition, she was trying to feed herself and not cooking properly. Its right before your eyes and you dont see it trade and you do, you see the difference of a life it makes. I took that with me when i became governor and the main thing i wanted to do is create programs that drew attention to help people because they live independently. We started some programs in West Virginia that im not sure had ever been started before. And tablelottery fund games at licensing fees. 100 went into longterm care for independent living. All theit fair. Programs that was whatever you pay, you pay. Intolp and we sent people live independently. A lot of people did not have Family Support area government doesnt have to do it all, but we have to be the best partner they have ever had. That starts from the federal to the local levels. Andad a Lighthouse Program we had the fair program, families with alzheimers. You just need a break every now and then. There are some compassionate things we can do and it doesnt break the bank to do it. Im thankful that those of you dedicated your lives to helping those of us who have it on the front lines. My sisters and my nieces take care of my mother around the clock. We never put her in a nursing home and thats not where she intends to be or where she wants to be and most people dont. The support, have we have to give them the support and we look forward to your testimony. Thank you. Season tell the holiday has begun. Were sitting democrat, republican, democrat, republican. This is an odd angle for us. Im feeling lonely over here. I just did not want to get to your left. You are welcome anywhere, anytime, senator scott. , the issue of longterm care is an issue i take seriously and when i think through my grandmother was 77 when she passed away in 2001. She had parkinsons and alzheimers. The last seven years of her life, my family, thank god for my grandfather, my mother and aunt who spend an inordinate amount of time taking care of her at their home. Fortunately, we had the resources to do so. When you look at the demographic breakdown of who can stay at home and who cannot, minorities pay a heavy price that having the resources and adequate time to care for their loved ones. We had a unique experience of a very special way. I think its a wonderful opportunity to care for those who took care of you. Theres an old saying that you are twice a child. Unfortunately, we have experienced this, those who have had the opportunity to care for a loved ones. This is why this issue is incredibly important for our country. The second experience has been as the guy in the Insurance Industry for the last 23 years where i sold longterm care policies and understand the activities of daily living and how many people have not been properly educated on the opportunities to make a decision when you are young enough so that the payoff is you dont exhaust all your resources trying to get down to the 2000 or 3000 level where medicaid tics in. 1. 2 million 1. 2 billion medicaid has put out. You have a conversation about where we are going as a nation and how the government can play an Important Role is a very important decision. Thank god for a chairman and Ranking Member who have the foresight to put us in this position and i look forward to having a robust discussion about the future opportunities and creativity in the marketplace that will provide that type of resources and invest real hope that more americans will retire and live for the rest of their time with the mentee to include the last years of their lives. Time with dignity to include the last years of their lives. We are going to start with ms. And tomlinson, the Senior Vice President s at hell of your health. Halavier health. Then we will hear from members of the longterm Care Commission. They are going to share. Thebruce chernoff, president and ceo of the scan foundation. He served as the chairman of the longterm Care Commission. We will hear from the adjuncts dollar at American Enterprise institute. He is the commissions vice chairman. Fetter, one of the commissioners of the Long Term Care commission. Is a professor at Georgetown Public Policy Institute and a fellow at the urban institute. He also served at the Pepper Commissions staff director under my former colleague of which i was the president of the claude upper fan club. She served for Claude Pepper. There was an example for those of you who were not here in washington in that youre a, Claude Pepper and Ronald Reagan would go to it. But at the end of the day, they were personal friends where they could work it out together. One of the great examples of that, also with the leadership of the speaker, tip oneill, was when Social Security was within six months of becoming bankrupt in 1983. They said we are going to take it off the table so you cant hit your opponent over the head with it. They appointed a Blue Ribbon Panel and made their recommendations on what to do. They sent it to the congress and we passed it overwhelmingly. Securityocial actuarially sound for the next halfcentury. That was 1983. So those folks knew how to get along. Chairman nelson, Ranking Member holland and Ranking Members of the committee, thank you for holding this hearing and for the opportunity to testify but the future of longterm care policy. The perspective im about to share comes from my work over the past 20 years, first at the office of management and budget as the person responsible for the Medicaid Budget. Or 15 years,0 consulting for nursing home and assisted living providers and working with a number of my colleagues on the panel analyzing the budgetary impact of a variety of ideas including the class act. Weant to start by saying spent well over 200 billion that we paid for very little care. Over 60 million americans provide most of the care unpaid. Mostdo this because americans are not insured against the financial risk of longterm care and want to avoid a medicaid nursing home bed. Woefullyterm system is underfinanced for the job has to do now and for the job has to do in the future. All the other problems we talk about, the Delivery System, workforce, quality of care, all stem from this fundamental fact of financing. Im going to make three points that i hope will help you all in the work you are doing in the future that will make our discussion a very interesting one. Im going to start with something controversial and hopefully a former governor will not come across the table at me. The farc the problem we have to solve primarily is not one that is a Medicaid Budget problem. And i worked on the Medicaid Budget for many years. I dont see this as primarily a Medicaid Budget problem. It is an issue of course. States have to fund their medicaid or grams and there are people and title ii services under those programs. Governors and state governments will face challenges as the population ages. But in managing these challenges, even more of a financing gap will be created and that will have to be filled by families through their own personal finances and unpaid caregiving. Longterm care is shrinking as a percentage of the Medicaid Budget. At its lowest percentage in two decades. Over the last 10 years, spending of grown at an annual rate less than five percent a year. It true that we will have Older Americans but in preparing for these demographics, states are doing smart and logical things from a budget perspective and theyre demonstrating they can and they will exercise the levers they have to reduce the number of people who receive longterm Care Services at the amount they spent per person. And they will do it in all settings, not just Nursing Homes. We see that already in the growing interest among states and moving people into managed care and out of fee for service. The number of people who will need longterm care, therell be less medicaid to beast right around. So my second point is the inability of medicaid to keep up with the growing demand. 2 the real problem. That the under financing of longterm care creates and contributes to a Enormous Economic and security, which is already a major problem in this country. Is an insecurity for the majority of American Families in that they think about what they might be facing in the future. When theyre faced with this crisis, most americans cobble together a variety of resources to provide what they can. Less than 2 million of the 12 million we talked about today who need longterm care are living in a nursing home. Thats because the rest live in the community where medicaid dollars are scarcest and were third of American Families provide some type of caregiving. Somehird are providing level of caregiving. When they provide this care, they do it at a rate of 20 hours per week. That time is spent doing the really hard, physically and emotionally challenging work of caregiving. They do it while 75 of them hold down another job grade we know that a Million People are paying privately for assisted living or other type of Senior Housing and the cost 42,000 a year on average. This is not just for rich people. This is being financed to the sales of homes, contributions from Adult Children and the resident exhaust resources and have to move into a nursing home to continue their care under medicaid because medicaid is not a cover assistedliving. Very little of this is captured in our data. Working directly with providers, my conclusion that it is much more likely medicaid is generally viewed as something to be avoided rather than a mechanism to exploit for wealth or faction. As someone whose job it was to work on finding medicaid savings that he wasnt shy about it, im telling you theres not what to suggest we have an enormous opportunity. In fact its quite the opposite. My idle point and this is the least popular point that will be made here today even when people are educated about the risks of longterm care and when they are presented with long willinsurance policies, we not truly address under financing without requiring everyone to participate in the risk pool. After being a proponent of expanded coverage through voluntary private approaches. And analyzing the budgetary impact of these. I learned from that experience and have the view now that two adequately protect americans against the risk and correct for the under financing problem we currently deal with, some part of the solution must be mandatory participation. We have a vigorous debate over private versus public options but it doesnt mean anything because neither works for a well and covering enough people is optional. Its an important debate for sure, but not one we should be having without facing the reality of what it will take to protect americans. I look forward to your questions. Thank you. Thank you, mr. Chairman, Ranking Member collins and members of the committee. We are pleased to be here to present a vision and recommendations of the longterm Care Commission and i want to going tosaying im walk us through the highlights of the report. This is work mark and i did together at and it comes from a spirit of fundamental bipartisanship which we think is the way forward. Im going to make some comments on behalf of the whole report. As you know, the commission had a very compressed timeline. We were set out with a sixmonth schedule after going through the appropriations ross us, we have somewhere between 90 and 100 days to do our work. We had four public hearings with ready for witnesses, over 100 submissions of public testimony and 100 sessions. By a 96ission voted majority to issue the report as the broad agreement of the commission. I want to provide you with an overview of the process and the development of the final recommendations and begin by saying the commissioners were a talented, knowledgeable and Diverse Group of people and our expectations were we would identify as much Common Ground as possible and establish that as a foundation for moving forward. The discussion and areas of agreement and disagreement would the evidencebased and we would be open and willing to challenge accepted thinking where we could not find substantial evidence the we are pleased with collegiality and amount of Common Ground reached grade this makes the point that addressing Longterm Services is not an intractable problem. Each commissioner was asked to submit proposals. Our all proposals are included in appendix a of the report. Measures selected the idea they felt merited the most attention developed for potential recommendations. Proposals that could not be developed were not included as final recommendations. Let me state clearly that developing a thoughtful, comprehensive report in 100 days is an important succ