If you thought the politicians' recent stomach-turning brinksmanship over the national debt ceiling wasn't fun — and who did? — you have no reason to look forward to the end of November and December.

A super-powered bipartisan “deficit reduction panel” has until Nov. 23 (the day before Thanksgiving) to make recommendations on where to cut about $1.5 trillion in spending. Then, the full Congress has until Dec. 23 to pass cuts. Bah humbug, indeed.

This isn't going to be pretty to watch.

Long-term care providers dodged some big bullets in the August agreement. But that was just the first round of shooting. There likely will be a lot more funding blood spilled by the end of the year. Operators could be swimming in it.

While Medicaid, Medicare and Social Security were among the exempted areas initially, they'll be fair game in this second phase of cuts. It's not known how much more lawmakers might try to take away with long-term care providers already in line to lose an average of 11.1% in Medicare funding on Oct. 1. The super-panel could inflict even more reductions.

The CLASS Act, despite being offered up as a sacrifice in other deficit reductions plans, was given a reprieve. By the end of the year, however, lawmakers could strip away most of the $120 million slated for start-up efforts next year. If things really turn south, full repeal of the nation's first long-term care benefit could be put back on the table.
As for Medicaid, payments to providers will drop. Beneficiaries' eligibility options and benefits also could be reduced. Don't be surprised to see states granted more flexibility.

There is little question that non-Medicaid benefits are going to take a big hit. The provider community will surely feel ripple effects.

If politicians can't meet their end-of-year deadlines, automatic “trigger” cuts of 2% will kick in. This is a default position lobbyists began fighting almost immediately. Medicaid would be exempted, but providers' Medicare funding would be at risk.

There's going to be an extraordinary blizzard of rhetoric and political posturing as 2011 winds down. It's liable to make all the hot air coming out of Washington the past few months feel like a cool summer breeze.