Judd Gregg admits that the failure of the Affordable Care Act’s long-term health care program CLASS won’t unravel the entire health care law in this morning’s interview with the Washington Post’s Sarah Kliff, but the former Republican senator offers some rather surprising explanations of why he included an amendment in the law that requires the program to remain solvent for 75 years. Last week, HHS Secretary Kathleen Sebelius cited Gregg’s provision as a reason for why the government has stopped implementing CLASS. From the interview:

SK: Tell me more about why you decided to offer that amendment.

JG: I knew we weren’t going to kill the CLASS Act because it was Sen. Ted Kennedy’s proposal, and he was very sick, and most of us were very sensitive to the fact he was sick. This was his last hurrah, legislatively. I knew we were going to implement it, although I didn’t think the concept was sound. Conceptually, it makes sense to prefund long-term care insurance…. but what this bill did was just the opposite. It was totally unsound. [...]

SK: Does the end of the CLASS Act say anything about the rest of the health law? Or is this an isolated incident?

JG: This was a sidecar. This was not a core element of the overall bill. It was put in as a courtesy to Sen. Kennedy. I do happen to think the overall bill is going to massively fail on the fiscal side and probably fail on the substantive side too. But you can separate off the CLASS act as not having an effect on the underlying bill, even though the underlying bill will also fail.

This won’t read well to the people who had worked by Kennedy’s side for years trying to build a program that would provide some very basic health care services to people who need help taking care of themselves. Nor should it. Gregg knows full well that the program could work if one were to include a mandate or tinker with the eligibility and premiums to ensure that it attracts enough healthy enrollees to keep it sustainable over the long term. To say that CLASS is a pipe dream included in the law to appease a dying senator is not only offensive but also very untrue.

As baby boomers express concerns about financing long-term care needs at the end of life, Republicans are preparing a new campaign to repeal the Affordable Care Act’s CLASS Act — a long-term care program designed to protect people who are disabled or elderly and need special assistance eating, bathing, or getting dressed. Last week, the administration announced it would suspend implementation of the voluntary program after failing to design a model that would comply with the requirements of the law and build a sustainable program for a period of 75 years. While HHS is pledging to continue exploring alternatives, the GOP is calling for its immediate repeal. “Hopefully we can kill this thing once and for all so it doesn’t become a drain on our children and grandchildren,” Sen. John Thune (R-SD), a sponsor of the repeal measure told the Hill.

It’s an ironic statement, given that “children and grandchildren” often go bankrupt trying to meet their’ parents long-term care needs. Since Medicare does not provide long-term benefits, Americans spend more than $200 billion a year on services in nursing homes, at home, or in assisted living facilities. Impairment is impossible to anticipate or save for (about four in 10 people who need long-term care are actually under the age of 65), and families rarely purchase private coverage or falsely assume that Medicare will cover their needs. As a result, families spend down to “$2,000 in financial assets” to qualify for long-term care under Medicaid. The program is now the largest single provider of long-term care — it spent more than “$100 billion last year, over one-third of its budget” and “paid more than 40 percent of the nation’s total long-term care bill.” By mid-century, the Congressional Budget Office (CBO) predicts that Medicaid will swallow 16 percent of anticipated federal revenues to fund care for the baby-boom generation.

CLASS, originally championed by the late Sen. Ted Kennedy (D-MA), sought to fix the system by establishing a national insurance program financed by voluntary payroll deductions from employers who agree participate in the benefit. Workers who pay into the program for at least five years, would receive at least $50 per day that could be used to pay for home-based or institutional services. But from the very beginning, economists worried that CLASS would have a hard time attracting healthier applicants and eventually pay out more in claims that it would collect in premiums. Secretary of Health and Human Services Kathleen Sebelius had responded to the criticism by reassuring Congress that “the program will not start unless we can absolutely be certain that it will be solvent and self-sustaining into the future” — a promise that she is intent on keeping.

But lawmakers can only deliver on the promises of long-term health care coverage if Democrats insist on making the program work. And therein likes a unique opportunity. The CBO has estimated that CLASS will reduce the deficit by $83 billion over 10 years. Republicans and Democrats who are truly interested in lowering costs — and national health care spending on long-term care — have an incentive to adopt legislative changes in the super committee that would the sustain the program for the statutorily required 75-year period. Judy Feder, Harriet Komisar and Paul Van De Water have laid out several legislative options for how to help the voluntary program attract enough healthy enrollees and lawmakers can look to them as an important starting point. The options include: 1) indexing benefits to inflation to make the coverage more attractive to younger workers, 2) tightening the eligibility requirements to “screen out people who already have serious functional impairments,” 3) increasing penalties for late enrollment, 4) appropriating more funds for marketing the program to younger workers.

Politically, Republicans see the possibility of eliminating CLASS as an opportunity to deal a severe blow to the President. But in reality, they would only be accelerating to the country’s long-term care crisis and reinforcing the belief that mandates are necessary for establishing balance in health care risk pools.

At last week’s presidential debate, Newt Gingrich resurrected the claim that the Affordable Care Act includes “death panels” — Sarah Palin’s description of a provision in health care reform that would compensate providers for counseling patients about end-of-life care. Gingrich incorrectly applied the phrase to the U.S. Preventive Services Task Force’s draft recommendation that men shouldn’t be routinely tested for prostate cancer.

Jonathan Cohn and I debunked the claim here and here, and now the New Republic’s Alec MacGillis is out with an interesting piece noting that Gingrich’s statements are not only wrong, but also highly disingenuous. The former speaker of the House had supported advanced directives in 2009, lauding the practice of talking patients through all medical options — and in many cases avoiding unnecessary end-of-life care — as an important cost-containment mechanism:

Not surprisingly, the hospital relies more heavily than others on palliative care and spends 30 percent less than the national average on end of life medical treatment. As one admirer put it in a July 2009 blog post, “If Gundersen’s approach was used to care for the approximately 4.5 million Medicare beneficiaries who die every year, Medicare could save more than $33 billion a year.”

That admirer? Newt Gingrich. The former House Speaker had close knowledge of Gundersen’s approach: in 2006, the father of his wife Callista passed away at Gundersen after a battle with lung cancer. Gingrich has been open about how well the hospital handled his father-in-law’s end of life care. “What they create is a family relationship in a difficult period so that the familiesup being very satisfied,” he said in an April 2009 article in the Columbia (Mo.) Daily Tribune. “The families feel there was dignity, there was dialogue, people were collectively doing something.”

Prior to joining the presidential field, Gingrich had regularly supported sensible health care reforms from the individual health insurance mandate to delivery reform. For instance, Gingrich has promoted CMS administrator Don Berwick, praising the physician for what Republicans (including Gingrich himself) are now characterizing as “rationing”: his work to improve the quality of the nation’s health care system. In early part of the last decade, Gingrich “gave credibility and visibility to a set of ideas being talked about in the health policy world about using information technology to improve medical care.” He advocated “reforms such as ‘data-driven reimbursement’ informed by best practices, a national electronic health network and a focus on prevention and wellness.

An Amazon search of Gingrich’s Saving Lives & Saving Money reveals three separate references to Berwick — who was and still is a national leader in improving health care quality — in which Gingrich praises the current CMS head for his passionate belief that quality-care focused systems improve health outcomes and reduce health care spending. Gingrich even included a plug for Berwick’s nonprofit, the Institute for Health Improvement, reprinting the organization’s website on page 122 of his book. In an August 2000 Washington Post op-ed calling on President Bill Clinton to “stop defending inefficiency and to drag health care into the 21st century by insisting on modern management and information systems,” Gingrich singled out Berwick for spreading the word about “quality control.”

Sen. Olympia Snowe (R-ME), who is up for re-election in 2012, did not endorse a Republican proposal to increase the Medicare eligibility age and block grant the Medicaid program, Politico’s Matt DoBias notices. “Snowe was one of two GOP committee members who didn’t sign onto the Finance Committee Republican recommendations to the deficit supercommittee. The other was Jon Kyl of Arizona, and his absence was less notable because he’s a member of the debt panel”:

It was Snowe’s concerns over the potential for block grants, stricter Medicare enrollment requirements and possibility for cuts to Social Security benefits — and not the threat of repealing the reform law — that precluded her from signing onto the committee’s proposals.

“I spent a great deal of time reviewing the proposals and agree with many of them,” Snowe said in a written statement supplied by her office.

There were other areas of disagreement, too. Snowe wanted to require pharmaceutical companies to discount drugs used by some of Medicare’s costliest patients. Her Republican colleagues have been cool to idea.

Some of the committee’s health savings proposals are far from controversial and have been included in President Obama’s deficit reduction plan and the fiscal commission’s report. But the Medicare eligibility and Medicaid block grant restructuring are big stumbling blocks for election wary politicians because they are unpopular and face political opposition from within the Republican party. As Mississippi Gov. Haley Barbour (R) recently explained at the unveiling of the Republican Governors Association’s health policy report, “not all Republican governors may want a block grant. … It’s up to the states to decide.” Governors fear that converting the existing matching rate formula into a block grant would provide states with less money that they would have otherwise received and force local governments to cut eligibility to the program.

A Washington Post/ABC News poll conducted over the summer also found that 72 percent of Americans oppose cutting Medicaid spending — including 59 percent of self-identified Republicans — and 54 percent are against raising the Medicare eligibility age.