John O’Connor

The thought of fiscal sweeteners in the Build Back Better Act has had many operators humming “Happy Days are Here Again.” But after what played out this past weekend, “Slip Slidin’ Away” might be a better choice. 

For this musical transition, operators can thank Joe Manchin. Lately, the West Virginia Democrat has been setting up more roadblocks than police chasing a DUI quota.

And after weeks of begging their reluctant colleague to come around, Congressional Democrats are now conceding what has been pretty obvious for some time: Manchin is not going to provide the lynchpin vote needed for the BBBA to pass this year.

But it’s not just a loss for the Democrats that’s at stake. It’s potentially a huge loss for operators as well. The proverbial carrots in the proposal include nearly $1 billion in grant funds to help facilities improve wages, benefits and infection-control efforts.

I’m not a long-term care provider, nor do I play one on TV. But those strike me as some pretty good things.

Now to be sure, there are some sticks in the legislation as well. They include $325 million for conducting reviews of survey enforcement and processes and a fresh $100 million to ensure no less than 3.5% of all nursing homes get brought into the Special Focus Facility program.

While the latter provisions might cause some operators to chafe a bit, it’s still a very good deal for the sector overall. Or should I say it was a good deal?

By any objective measure, Manchin has used his singular clout in a way benefiting a complete weasel. Case in point: First he played the fiscal responsibility card as a reason he couldn’t sign on. Now some might say that’s a peculiar position for a Democratic Senator from one of the poorest states in the nation to embrace, but there you go.

He was shocked, shocked that the plan came in with an estimated cost of $3.5 trillion over 10 years. Get it down to $1.75 trillion if you want his vote, Manchin insisted. Now that the lower number has apparently been reached, he has newfound concerns: He’s not happy with the way the numbers were driven down.

Manchin’s latest complaint is raising concerns among some Democrats that no concessions will be good enough to meet whatever future litmus tests he might invent.

Of course, it’s also very possible Manchin’s simply trying to negotiate the best possible deal for himself and his largest donors before signing on. Let’s hope that’s the case. Because any way you slice it, his recalcitrance here is anything but good news for the long-term care field. Things were financially precarious in this sector before COVID-19 came along. And they have only become more desperate since.

Delaying or denying much needed money could very well fuel the closing of facilities in West Virginia. It could also mean that many sick and old West Virginians won’t get needed services. Some might even perish.

Should those things happen, many of the people who helped put him in office just might respond with a memorable vote of their own.

John O’Connor is Editorial Director for McKnight’s