We’ve been talking about it for months and now the day of reckoning has almost arrived: Election Day is just one week away, and the stakes could be very high for the skilled nursing crowd.

The makeup of Congress and the Senate swing in another direction, leading to possible reshaping of Medicare and Medicaid policy, but 36 states also have gubernatorial elections this year, which will determine Medicaid expansion considerations. Idaho, Nebraska and Utah — also will ask voters to weigh in on Medicaid expansion. As my colleague Elizabeth Newman pointed out on Friday, there are also a slew of other local ballot considerations that could have an impact on nursing homes, ranging from the legalization of medical marijuana in Utah, to nurse-patient ratios in Massachusetts.

Perhaps worried how all of this uncertainty will impact investor sentiment, several eldercare operators interestingly all scheduled their earnings releases on Election Day next week, ahead of the other shoe possibly dropping in the evening. As American Health Care Association chief lobbyist Clifton Porter II noted at his organization’s annual meeting earlier this month, a swing in the favor of the left could spell more regulation, while maintaining the current makeup could mean cuts to payment programs.

“Republicans want to cut your jugular vein, folks. It’s called Medicaid. And Democrats want to cut your femoral artery. It’s called more regulation and let’s figure out a way to sue you into oblivion,” Porter told attendees. The two often conflicting forces are always at work, forcing providers to play both sides of the street, he reminded.

That’s why, he believes, the ideal outcome for operators would be a split, with the Democrats taking back control of the House, and the Republicans keeping the Senate. With that, it’s hopeful that the two sides could keep each other in check, and limit those slashes to your proverbial jugular vein and femoral artery. Of course, there’s always the possibility, too, that both sides have to come up with a “grand bargain” to solve impending budgetary issues, and operators’ payment streams “end up being on the menu,” as Porter put it.

With so much at stake for the business next week, I would hope that you’re out “pounding the pavement,” advocating for the issues that matter most to your facility in this election.

Porter called it “a responsibility” for each provider.

So, get out there and make sure your concerns are heard — before voters head out to their polling places and decide your fate.

Follow Staff Writer Marty Stempniak @MStempniak.