Brendan Williams

In December 2000, President Clinton vetoed the Bankruptcy Reform Act of 2000 citing a “loophole for the wealthy” among other concerns.

Five years later, as the euphemistically-named Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 neared passage, a Delaware senator was thanked by Republicans on the Senate floor for having “worked tirelessly for years on this legislation[.]”  That senator: Joe Biden. In an editorial – Bankrupt Bankruptcy Bill – the New York Times stated  “the bill is a gift to the credit industry and deserves defeat.” Instead, it was signed into law by President Bush. 

Now President Biden, born again as a populist, has identified what he feels is the top healthcare sector threat to consumers. 

Is that threat drug makers? After all, they’re not doing too bad under a president who campaigned on this promise: “I’m going to lower prescription drugs by 60%, and that’s the truth.” 

On March 13, 2020, the day a federal directive shut nursing homes down to visitation, group activities and communal dining, Moderna’s stock was at $21.30. It closed this February 28 at $153.60. And taxpayers helped. The Biden Administration reportedly diverted $7 billion from the Provider Relief Fund to Moderna and other drug makers for COVID-19 vaccines, on top of the largesse received under Operation Warp Speed.

Thus, the threat to healthcare consumers President Biden has identified can’t be drug makers. 

Might the threat be health insurers? It can’t be, since the Biden Administration proposed an 8% increase in revenue for insurers offering Medicare Advantage plans.

The perceived threat revealed

So, you might ask, what is this perceived threat being addressed by President Biden’s plan? Surely, you may assume, it cannot be the nursing home sector that, according to research, has offered the largest wage increases of any healthcare sector during the pandemic? And yet it is. A White House “fact sheet” implies that “the tragic impact of substandard conditions at nursing homes” accounts for resident deaths from COVID-19 – maybe even all of them (it’s hard to tell).

In assessing this claim, let’s first set aside the fact that Biden said former New York Governor Andrew Cuomo did “a hell of a job” even after it was revealed Cuomo had flooded nursing homes with hospital discharges positive for COVID-19 and then lied about the catastrophic outcome. 

Let’s look instead at the White House “proof” offered in support Biden’s plan, which includes the fact that “[t]he Government Accountability Office found that, from 2013 to 2017, 82% of all inspected nursing homes had an infection prevention and control deficiency, including a lack of regular handwashing, that was identified through Medicare and Medicaid surveys.” 

Taken out of context, that certainly does sound alarming, but ignores some nuance about surveys.  What the White House should have added is a quote from the report: “[N]early all infection prevention and control deficiencies (about 99 percent in each year) were classified by surveyors as not severe, meaning the surveyor determined that residents were not harmed.” (Emphasis added).

Moreover, infection control challenges in healthcare are not confined to nursing homes. 

The CDC has acknowledged that the rate of Healthcare-Acquired Infection (HAI) is higher in hospitals than nursing homes, and that “[t]here were an estimated 687,000 HAIs in U.S. acute care hospitals in 2015.  About 72,000 hospital patients with HAIs died during their hospitalizations.” 

Consider also a Feb. 18 Wall Street Journal article: “As the Omicron variant surged through communities across the U.S., it also spread inside hospitals and infected non-COVID-19 patients, reaching a record number, a Wall Street Journal analysis of U.S. government data found.” 

I point these facts out not to pick on hospitals. Infection control is hard work in either a hospital or nursing home, made all the more so by a fantastically-contagious coronavirus. But why single out nursing homes?

Biden’s plan will push providers to edge

To identify for criticism a single nostrum the Biden Administration prescribes is difficult, but here goes: The Administration reverts to the illogic that the key to improving quality at nursing homes, which are chronically underfunded by government through Medicaid, is to fine them. Under this theory, excellence can only be achieved by removing resources to improve performance. 

Thus, “President Biden is also calling on Congress to raise the dollar limit on per-instance financial penalties levied on poor-performing facilities, from $21,000 to $1,000,000.” Why stop there? If the apparent goal is to bankrupt a facility, and displace all its residents and staff, why not raise one-time fine limits to a billion dollars? That would also be consistent with an ideology where the only healthcare sector where any financial viability is begrudged is the nursing home sector.

As someone who joined healthcare partners, including hospitals and members of Congress, in publicly fighting the efforts of the prior administration to eviscerate Medicaid, it is heartbreaking to see so little regard from the current president for a healthcare sector that, broadly, has performed heroically in the face of an unprecedented public health emergency. 

There was not a single word of praise for nursing homes in the White House “fact sheet” broadside, just as there was no help for nursing homes in an American Rescue Plan Act boondoggle that showered cash on everyone else.  I cannot imagine anything more demoralizing for my members, who are already staggering at the edge of a precipice.

Brendan Williams is the president and CEO of the New Hampshire Health Care Association.