Medicaid. PACE initially demonstrated positive results30 but was slow to expand and remains small, due to factors such as low awareness about the program and its services, a lack of financing alternatives to Medicaid, and competition from other service providers.31 Market Reforms: Complementary proposals for reforms aim to empower consumers of long-term care insurance marketplace by standardizing policies, creating electronic marketplaces, and developing consumer protections and appeals processes. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required some standardization of LTC insurance plan eligibility triggers as a condition of preferred tax treatment.32 30 Addressing the Health Needs of an Aging America | 31 33America’s Health Insurance Plans, Who Buys Long-Term Care Insurance in 2010–2011? A Twenty Year Study of Buyers and NonBuyers (In the Individual Market), March 2012, available from: http/ 35Id. 36Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Long-Term Care Insurance, ASPE Research Brief, June 2012, available from: http://aspe.hhs.gov/daltcp/reports/2012/ltcinsRB.pdf 37Id. 38Id. State Policy Levers Tax Credits for Long-Term Care Policies: Organizations like America’s Health Insurance Plans (AHIP) recommend subsidizing the purchase of long-term care through refundable tax credits in order to enhance access to private long-term insurance. These credits could guarantee that assistance is available to individuals, regardless of whether or not they owe federal taxes. Savings in Medicaid costs could also be used to finance the tax credits. According to one AHIP study, 75 percent of Americans do not believe that it is “the government’s responsibility to pay for the long-term care needs of everyone,” and about half of respondents over 50 supported tax incentives to purchase LTC insurance.33 Nearly half of states offer some form of tax deduction or credit to purchase LTC insurance, which results in an average reduction in cost of 5 percent and an estimated increase of 2.7 percent in the purchase of private LTC plans. However, most of this increase is attributed to individuals at the upper end of the income distribution who have a minimal risk of spending down into Medicaid.”35 Long-Term Care Partnership Programs: These programs allow individuals to purchase long-term care insurance and protect some of their assets if they exhaust their insurance coverage and spend down into Medicaid eligibility. Over 40 states currently participate in the Partnership Program, but less than 10 percent of active LTC insurance policies are partnership plans.36 It is unknown whether the Partnership Program has increased the purchase of private LTC.37 Connecticut was one of the first four states to implement that partnership program in the 1990s. Over the first nearly 20 years of the program in Connecticut, out of 53,064 purchased policies, only 95 claimants used up their private benefits and spent down into Medicaid.38 Medicaid Carve Out: This approach would give individuals the opportunity to use their expected Medicaid benefits as a subsidy to purchase permanent long-term care insurance in exchange for the right to future Medicaid LTSS. Addressing the Health Needs of an Aging America | 32 Conclusion Unless policymakers take action soon, changes in the care needs of the aging population will likely push our current healthcare system to its breaking point—with significant and negative consequences for older adults and their families. This study identifies immediate and medium-term opportunities to adapt to this generational and demographic shift with actionable, evidence-based reforms to: • Expand prevention and wellness efforts; • Address gaps in the caregiver workforce; and • Improve care coordination. Further collaboration between policymakers and researchers in these focus areas is likely to yield success in improving the health of our aging population. There are also opportunities for more long-term investment in policy development and analysis. In focus areas such as patient self-