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There are two major government health insurance programs in the United States---Medicaid and Medicare. Medicaid is for poor people and Medicare is for old people. Medicaid is a Federal/state government health and long-term care program for low-income and Americans without significant economic assets. Medicare is a Federal government health insurance programs for Americans who are age 65 and older or those under age of 65 who are disabled and unable to work.Increasingly, there is an emerging emphasis in the United States to provide long-term care services in the home and community-based settings. The total experiences for LTC services in the home were $ 37 billion or Yen 4.6 trillion in 2000 and the demand is projected to grow. Many states are concerned about their ability to continue support for Medicaid long-term care services because of increasing fiscal pressures.

Second concern is that most public funding goes for institutional care. Almost 20% of the people who receive services reside in nursing homes - yet 70% of total long-term care spending is for nursing home care. In the United States, the average cost of nursing home care last year was $57,000 or Yen7.1 million.

Many experts believe that state and Federal policies have a bias in favor of nursing homes. In the United States, families who receive little or no assistance from government programs provide most long-term care. About 60% of seniors receive care at home or in the community. They rely on unpaid caregivers, primarily spouses and adult children.

Finally, with increasing demand for long-term care services, quality is an area where we are always paying close attention. Nursing homes are subject to Federal oversight and regulation. Assisted living is currently regulated by states. Because assisted living is the fastest growing industry providing long-term care, there are no uniform quality standards for states to use. My own Senator, Senator Craig, and other members of Congress are working to develop sensible standards that ensure high quality and consumer protections while maintaining flexibility that seniors prefer.

The need for long-term care in the United States is expected to grow significantly in coming decades. Two thirds of the people receiving some form of long-term care services are over 65, an age group expected to double by 2030. After 2030, even faster growth rates are anticipated for people over 85, the age group most likely to need care.

There is some question about whether the growth in long-term care spending will rise as rapidly as the number of senior citizens. Disability rates among the elderly have been declining over the last 20 years. If this trend continues, the elderly of the future may be healthier, which may reduce their need for care. On the other hand, increased longevity later in their years.

It is unclear how the increasing costs for long-term care will be financed. The outcome depends on how fast the economy grows and what policy changes are made. The issue is complicated because of the shrinking worker to retiree ratio in the United States. This demographic fact will make it difficult to maintain future Social Security, Medicaid and Medicare benefits at the current levels. Fewer workers and a growing demand for aging services will be a challenging task for policy makers.

The United States is taking some action. Congress recently passed a Medicare reform bill that for the first time in 38 years made some fundamental changes to the program. One of the key changes is the Health Saving Accounts, allowing people and employers an opportunity to contribute into the account for their healthcare needs. It also gives people more control over their care.


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