Kimberly Marselas

“Punishment over partnership.” A “debacle.” “Too little and misdiagnosed.”

Those are some of the phrases our readers used after evaluating the historical and heavy-handed enforcement strategies pitched by the White House this week.

I’d add “wholly unrealistic” to that list, and not just because providers can’t meet staffing minimums with few (or no) job candidates in the labor pool.

There are pretty decent odds many elements of the proposal will never see the light of day. And who should providers prepare to thank for that?

Why, the legislative branch, of course!

White House vision will require Congressional action

Several of President Joe Biden’s hardest-hitting initiatives would require nothing short of an act of Congress to institute change. That stands to make our 21st century Do-Nothing Congress a strange new bedfellow indeed.

Where just last week, operators and their lobbyists were still besieging representatives for more COVID-era financial support, nursing homes might now find themselves praying for continued legislative inactivity.

Realistically, what are the odds that a Congress that failed to address aging services’ needs through infrastructure or Build Back Better bills will now come to quick agreement on this new White House vision?

Biden’s Build Back folly got providers excited about a potential $800 million in grant funding for workforce and infection control improvements. But those elements now find themselves areas of punitive focus. They were front and center in a White House fact sheet Monday and brief nursing home comments in last night’s State of the Union.

Build Back also called on federal health officials to study ideal minimum nurse staff-to-resident ratios for nursing homes. Provider organizations were making headway on that, however. When the package collapsed, the two Congressional bodies were divided over whether those ratios should be mandated.

Could Lawmakers actually come together now? Are Democrats and Republicans suddenly more united? How does Sen. Joe Manchin (D-WV) feel about nursing homes, or about voting for something, anything?

Better yet, what would the legislative vehicle for these proposals be? This is a Congress that appears to be disinterested in small-potatoes but calls big-ticket items too expensive, citing pandemic spending and inflation.

Will they foot the bill?

That brings us to the second Congressional concern. What about the potentially steep costs associated with these measures? Clearly, members will be concerned about federal costs even if it’s already obvious the lowly provider shouldn’t expect any financial incentives to make this tectonic shift less unsettling.

But will a Congress running its own government on one continuing resolution after another — rather than the annual budget it is required to pass  — actually agree to add $500 million more for nursing home surveying activities (a 25% increase) to the Health and Human Services budget?

I, for one, highly doubt it.

There are provisions in the White House vision that could be very appealing to certain House and Senate members. Asking Congress to allow nursing home penalties to jump from $21,000 max per-instance to $1 million could please Democrats who see fines as a way to target under-performing facilities and potentially disincentivize private-equity investors from further involvement in the sector.

Then again, that could stop big business Republicans and those with data-collection sensitivities in their tracks.

The bottom line is that providers have much to fear in this week’s White House broadside. But given Congress’ ineffectuality; time for providers to comment before the Centers for Medicare & Medicaid Services enacts any changes on its end; and upcoming midterm elections, it may ultimately turn out the only thing to truly fear was fear itself.

For your sake, I hope so.

Kimberly Marselas is senior editor of McKnight’s Long-Term Care News.

Opinions expressed in McKnight’s Long-Term Care News are not necessarily those of McKnight’s.