Time to praise Medicaid and more regulations?

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John O'Connor
John O'Connor

If you see two providers having a pleasant conversation, it's unlikely they are discussing the joys of Medicaid -- or new regulations.

Both topics historically have been anathema. But these days, operators may have compelling reasons to view both with a little more respect.

Consider Medicaid. Yes, it has traditionally been the field's largest funding source. But it has always been eyed with a suspicion bordering on contempt. Such payments have a long history of being inadequate. And in many states, they tend to arrive notoriously late.

Small wonder so many of the big boys and not-so-big boys have shifted their attention to more generous funding sources, particularly Medicare.

What's so great about Medicaid? This: It's the main reason Obamacare was not killed.

Even if you are not a big fan of the law or the man it's colloquially named after, there's no getting around this simple fact: What the loyal opposition was cooking up would have been far worse for your business. One of the signature elements of repeal and replace is that it would have gutted Medicaid funding in the years ahead. (Some might prefer “restricted growth” to “gutted.” But when the cupboard is bare, it's a difference without a distinction.)

And if you are running a skilled-care facility, you just know some of that promised right-sizing would have been coming your way.

Fortunately for this sector, many governors feeling the pleasant effects of recent Medicaid funding infusions were in no mood to have the spigot turned down, much less off.

Lawmakers on both sides also heard from constituents who were counting on continued Medicaid support for things such as, well, staying alive.

The truth is, many GOP senators had serious misgivings about the various Republican prescriptions to revamp healthcare.  In the end, only three were brave enough to buck the Party. But they were enough to thwart an overhaul that seemed fairly certain when the year began.

So what do you do if you are in the White House and you couldn't get the legislation you wanted? You go to Plan B.

Tom Price, M.D., who is Secretary and Health and Human Services, quickly announced he'll be using new regulations to move the administration's healthcare agenda along.

New regulations are bad, right?

But just as we learned there are bad and good witches in the Land of Oz, so too can regulatory adjustments be harmful or helpful. In fact, regulations as a proxy for legislation may prove promising for three reasons.

The first is that skilled care operators will be able to weigh in on the relative merits and drawbacks of any new rules that are proposed.

The second is that the coming regulations will likely be more pro-industry in nature than if they were penned by Democrats.

Finally, they will be written because a repeal and replace effort failed.

So thanks to Medicaid and new regulations. Compared to what might have been, you're both looking a lot better these days.

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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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