Sen. Charles Grassley (R-IA) has been around so long that he addressed my civics class at Iowa City High School – and I graduated 33 years ago. Today, as an 85-year-old, you might think he would have more sympathy for our nation’s fragile long-term care system.
Instead, Grassley has used his position to attack long-term care in headline-grabbing ways. In a March 6 hearing on two instances of nursing home abuse, he pontificated: “I’ll continue to make it a top priority to ensure our most vulnerable citizens have access to quality long-term care in an environment free from abuse and neglect.”
Yet this was the same Sen. Grassley who, in 2017, supported the so-called Better Care Reconciliation Act an Avalere analysis showed would have cost his state $2.2 billion in Medicaid cuts by 2026. Then, in supporting the Graham-Cassidy bill, which (again according to an Avalere analysis) would have cost Iowa $28 billion by 2036, Grassley famously stated, “You know, I could maybe give you 10 reasons why this bill shouldn’t be considered.”
How would these measures have contributed to “quality long-term care”?
Grassley also has been mute as the excesses of Medicaid managed care insurers have ravaged Iowa’s long-term care system. The Iowa House, controlled by Grassley’s fellow Republicans, just voted to pour another $150 million in new funding into the gullets of managed care insurers that have too often failed to pay providers in a timely fashion, if at all.
As the Senate Finance Committee chair, Grassley could also weigh in on the perils posed to care by Medicaid block grants that the Trump Administration is pushing. Alaska is reeling from the severe Medicaid cuts proposed by its new Republican governor, Mike Dunleavy. Now Dunleavy reportedly wants the state to become the nation’s first voluntary block grant victim.
More heartening have been the examples of Republican governors in two other states.
In Nebraska, Gov. Pete Ricketts (R) proposed an additional $21.4 million for nursing home care; however, the unicameral legislature’s budget leader, a fellow Republican, wants to double that increase.
In South Dakota, Gov. Kristi Noem (R), embraced a 10% increase in nursing home funding a priority after rural facilities closed. She wrote that “[n]ursing home closures impact real people: our parents, our grandparents.” As she noted, “shuttered nursing homes mean disconnection from community, separation from family, and a disruption of comfort.” Paging Sen. Grassley!
Similarly, in Massachusetts, rather than taking the Grassley approach of browbeating nursing home providers, legislators are responding to a string of closures with a proposed additional $30 million in funding. As part of that effort, a legislator came up with a bill, incorporated into budget language, to create an emergency task force to address financial solvency issues for nursing home care – she reported 78 co-sponsors for her idea.
Grassley fails to understand that most nursing home care “neglect” – aside from a few bad actors he’s always happy to highlight – comes in the form of state and federal underfunding. And that neglect is quite intentional, as can be proven through exacting cost report data or the most recent report to Congress from MedPAC showing nursing homes operating in the negative without Medicare revenue, and only at an average .5% margin with it.
Rather than piling onto a beleaguered care sector with demagoguery, Grassley could recognize these realities. In the interim, here in New Hampshire, struggling facilities will continue to provide the best care they can. With a funding increase of only 17 cents per day this year, the day is not too far off when these facilities – to quote Noem – are “shuttered.”
Brendan Williams is the president/CEO of the New Hampshire Health Care Association.