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What Happened to Long‐Term Care in the Health Reform Debate of 1993–1994? Lessons for the Future
Author(s) -
Wiener Joshua M.,
Estes Carroll L.,
Goldenson Susan M.,
Goldberg Sheryl C.
Publication year - 2001
Publication title -
the milbank quarterly
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 101
eISSN - 1468-0009
pISSN - 0887-378X
DOI - 10.1111/1468-0009.00204
Subject(s) - medicaid , government (linguistics) , health care , health care reform , public administration , long term care , politics , administration (probate law) , political science , control (management) , economic growth , business , health policy , medicine , economics , nursing , law , linguistics , philosophy , management
During 1993 and 1994, the United States debated but did not enact major health care reform. Although the reform efforts focused on providing health coverage for the uninsured and controlling acute care costs, many proposals included substantial long‐term care initiatives. President Clinton proposed creating a large home‐care program for severely disabled people of all ages and all income groups, among several other initiatives. By stressing non‐means‐tested public programs, the president's plan was a major departure from the Medicaid‐dominated financing system for long‐term care. In designing the long‐term care component, the Clinton administration addressed many of the basic policy choices that must be decided in all reform efforts, including whether initiatives should be limited to older people or cover people of any age, how to balance institutional and noninstitutional care, whether to rely on government programs or on the private sector, and how to control costs. Analyzing the political and intellectual history of long‐term care during the health reform debate provides lessons for future reform.