The budget and a lack of friends

James M. Berklan
James M. Berklan

If there's one thing long-time political observers can tell you with certainty, it is this: You can make friends when you pass laws, but you rarely do when you propose a budget.

A budget proposal is bound to tick off anyone targeted for a cutback but only modestly raise hopes of those slated for an increase.

That's because those on the “winning” end know that a proposal is just that — a “we hope to,” not a promise. And besides, the amount is never enough anyway.

Then there are those who get the knife taken to them, like long-term care and other providers, in the budget proposal President Obama announced Monday. Losing, and even just the thought of it, are painful enough. Then there's the realization that whether or not the cuts go through, there are people of importance out there who think you deserve a funding pullback.

Sometimes the image damage is as tough to endure as the actual funding loss.

In the aftermath of Monday's administration release, there was no mistaking the pain in long-term care leaders' voices. Usually publicly released statements are full of murky language and hopes of “working together” instead out outright saying something's wrong.

Not so this time. This budget proposes close to $400 billion in cuts over the next 10 years from Medicare, Medicaid and other programs.

“We are very disappointed by the president's proposal for yet more across-the-board cuts in the annual Medicare payment update for post-acute care providers, especially nursing homes,” shot LeadingAge CEO Larry Minnix on Tuesday, which meant there was plenty of time for him to weigh what he would say and how he would say it.

As Minnix points out, the proposed cuts would be in addition to reductions already in effect under the Affordable Care Act and sequestration. He believes the recommended funding trims could result in nursing homes “receiving actual cuts in reimbursement to levels below previous years' payments.”

American Health Care Association leader Mark Parkinson was perhaps a bit more circumspect, mentioning a desire to be in on future negotiations. But he also called aspects of the budget “ill-advised.”

And to think that just a few short days ago, the talk of the budget possibly asking for the rollback of sequestration cuts was a cause for optimism.

The good news for providers is, a budget proposal like this is just that, a proposal, a wish, a platform statement. The really good news is that Congress is not controlled by the president or his party so there is no chance of it being passed 100% as proposed. Instead, it becomes a positioning ploy. In this case, definitely not the best way to make friends in the healthcare community.

James M. Berklan is McKnight's Editor. Follow him @JimBerklan.

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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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