The politics of why long-term care leaders are smiling

James M. Berklan
James M. Berklan

Sometimes when things go wrong, they're right. Oh, so right.

That's the position long-term care professionals now find themselves in — or at least hope they do.

Heading into the Nov. 8 elections, long-term care lobbyists were preparing for an entirely different script from the one they're now holding. Republicans swept the White House and BOTH chambers of Congress, to the surprise of even the most political of wonks.

Like a kid who had found extra presents under the Christmas tree, the American Health Care Association's lead lobbyist, Clifton J. Porter II, said perspectives changed overnight.

“It was a shock to all of us,” Porter told reporters during a media briefing Tuesday. Game plans had been made to deal with a divided government, the AHCA's senior vice president for government relations explained.

No doubt divisions will continue between Republicans and Democrats, and even among some same-party groups. But with the Republican dominance in Washington, there is no question things are looking up for providers. They'll still need to hope for Democratic strength when it comes to setting Medicaid and Medicare payment rates. But on the rules front, they historically find more friends among Republicans.

Personally, relishing a President Trump era might be political anathema to some. (See the comments here.) But dissenters need to recognize that at $150 billion, this is business. Very big business.

The latest gifts to the long-term care profession appear to be the president-elect's nominees to lead the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, who were announced Tuesday. Pending Senate confirmation, the next HHS Secretary will be a former orthopedic surgeon, a healthcare provider well known to, and reachable by, LTC folks.

“We feel both of these nominees will be proactive voices, and most importantly, understand the healthcare system,” Porter said about Rep. Tom Price (R-GA) and CMS nominee consultant Seema Verma, a trusted Indiana colleague of the vice president-elect.

While associations such as AHCA have to play nice with both sides of the political aisle, there is no question Porter and other LTC leaders are pleased with the Republican surge. He chuckled when recalling how Price has been “unafraid” to voice his disapproval of what he has seen as heavy-handed oversight by CMS. This is a big brother who will have providers' backs against the proverbial “Big Brother.”

Price chafes at the idea of having third parties making healthcare decisions, much to LTC providers' delight. What this might mean about the further formation of accountable care organizations and the wave of managed care sweeping the nation no one knows for sure. But things were looking a whole lot better after Price emerged as the HHS nominee.

“We're excited for myriad reasons,” Porter admitted. “Having that voice at the top [of HHS] should be incredibly helpful.”

Various provider groups might wind up battling at the same reimbursement trough, as usual, but at least the jostling would be among caregiving siblings, not as much with federal regulators (though dollars might be harder to come by overall).

Porter even marveled at the possibility that the massive new Rules of Participation could be rescinded. It's not likely, given the crowded first-100 days agenda being laid out with other priorities, he noted. But having friends in high places won't hurt, one way or another.

That includes House Ways and Means Committee Chairman Kevin Brady (R-TX), the very same Brady who spoke at AHCA's Congressional Briefing meeting in May.

Whether the Affordable Care Act is fully taken off the books by a Republican-led effort is yet to be seen. But clearly, a less stringent regulatory era is expected.

In fact, when I asked Porter what “good” parts of the ACA he might like to see remain, he laughed and said the former nursing home administrator in him couldn't think of many. Because of the “gazillion other requirements” long-term care operators have to deal with every day already, there would be joy in trying to discern duplicative, repetitive and unnecessary requirements that could be moved off providers' plates.

“The real question is what the next iteration [of regulations] is going to look like,” Porter noted. If the ACA is repealed, “a lot of the things we deal with” will potentially be postponed or put off altogether.

In addition, confidence is high that CMS's ban of pre-dispute arbitration clauses could be taken out of play. As with many policy issues, it's yet to be known how the Trump administration (or the courts) will react to a lawsuit against the Obama administration's proposed ban. But Porter noted that the Republican-led House has been “wholeheartedly supportive” of AHCA's push to retain arbitration options. Factor in a Republican-led Senate, and of course, White House, and the picture gets only rosier.

The bonuses of the Republican sweep don't stop there. Porter feels the movement for a national minimum wage has “gone away” and that a more business-friendly Department of Labor is around the corner. That could mean relief from the new overtime payment rule that will vastly increased the number of American workers eligible to receive overtime, starting Thursday.

Republicans also will become the majority on the president-appointed National Labor Relations Board, another win for employers.

“We will have a different approach from the Department of Labor from what we had in the past, hopefully one that is a lot more sensitive to the needs of businesses in America,” Porter observed.

It's an outcome few long-term care providers dared dream before Nov. 8.

Follow James M. Berklan @JimBerklan.

Daily Editors' Notes

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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