Former House Speaker Paul Ryan leads a keynote discussion at the NIC fall show. Credit: Tori Soper.

CHICAGO — Former US House Speaker Paul Ryan delivered on his mission of framing US economic and public policy issues here Tuesday, optimistically emphasizing that immigration reform and technology are the two best tools to help senior care operators overcome their dire staffing shortages.

But he probably raised the most interest among skilled nursing leaders at the National Investment Center for Seniors Housing and Care (NIC) conference when he explained Congress has a clear ability to block a federal nursing home staffing mandate if it has the collective will to do so.

“The Congressional Review Act gives us [Congress] the ability to pass a law that says that the minimum staffing rule is repealed because it was a bad rule,” said Ryan, who delivered Tuesday’s keynote. “It can’t be filibustered in the Senate. If it passes in the Senate, it happens and it goes away, no matter who the president is. That kind of stuff can happen.”

As part of a broader discussion of today’s partisan political climate, he noted that aligned interests need to control Congress and certain circumstances need to fall into place, “But you can repeal recent rules if you have Congress. So there’s a lot you can do.”

The Speaker of the House from 2015 to 2019, Ryan is now pursuing life in the private sector, frequently exercising his prowess in economics. That includes activities such as teaching at the University of Notre Dame and speaking before groups like the standing-room only crowd at the NIC fall meeting.

Ryan earlier expressed his disdain for the Biden administration’s September release of a proposed mandate.

“Even the Obama administration didn’t do that,” he said with a snort, interrupting moderator Bob Hillis, a fellow Wisconsite and the founder and CEO of Direct Supply.

When Hillis said the staffing mandate seemed like an almost “unsolvable problem,” Ryan gave reason for some optimism and offered paths to help. He noted, for example, that the Federal Reserve had reported wages had started to decelerate and “the wage spiral is over.”

Twin pillars

“We just need good immigration laws,” Ryan added, calling it “the real solution to this.”

He labeled immigration reform the hardest issue he had to work on as a legislator, after entitlement reform.

“But I’m convinced that like entitlement reform, immigration reform is going to get done for one reason — it has to get done.”

He said a key would be allowing more foreign workers. 

“You have guest worker programs. You have visas that are offered to fill big gaps in labor supply, which in the 21st century, you can do this in a technologically savvy way so that you’re not taking jobs away from a person who’s here. You’re not depressing a person’s wage,” he offered.

“This is always the argument with immigration reform and it’s a 20th century argument. In this day and age, we know how to do healthcare worker visas and agricultural worker visas and H1-B visas for software engineers and doctors and nurses … and we have people who want to come. From a pure economics point of view, that’s the only way … we can get our economy going back to a 3% trend of growth.”

Only “unserious politics,” is holding up a lot of progress, he said.

“The point I’m trying to say is it’s a ‘good-news story.’ It’s not an unsolvable problem. Immigration reform, which this industry desperately needs, will get done. [Democracy] is sloppy. It is slow. But it does get done, and I have every ounce of confidence that that’s going to happen here.”

He said technology issues have both domestic and international implications.

“The only way to fix this thing is technology, which gives you better productivity,” he noted.

“We have an explosion of technology coming into society with machine learning and quantum computing and artificial intelligence that can lend an assist to make you more productive in a SNF, in an assisted living facility,” he added. 

He emphasized that the US must create a regulatory framework for AI, and soon. And it should be done by lawmakers, he added, leading into a critique of regulators that mimicked some intoned by long-term care leaders frustrated with federal oversight.

“[AI oversight framework] should go through Congress and not the administration trying to wing it because I don’t think any of these government agencies have the stuff that they need,” said Ryan. He honed his observations as former chairman of the House Ways and Means Committee, which oversees the Department of Health and Human Services and the Centers for Medicare & Medicaid Services. “They don’t have the wherewithal to do this.”

He said such agencies have a tendency to regulate technologies “based on the past.”

“They’re always late,” he added. “They stifle new, emerging technologies and they work at this bureaucratic pace that doesn’t keep up with the times.”

Fed up on inflation?

Ryan also discussed the macroeconomic forces that have challenged providers over the last two years. He said the Federal Reserve must stick to its guns when trying to cool inflation to a 2% rate — and predicted it would take longer than many experts have predicted.

“We’re not going to hit that until 2025, at the earliest, I imagine,” Ryan told the crowd, which included hundreds of lenders and capital providers. “What that means is [Federal Reserve Board Chair Jerome Powell is] going to keep [interest] rates even longer than I think the market seems to think. Getting from 8% to 5% inflation, easy. Getting from 5% to 2%? Really hard.”

He said to plan for “more expensive capital for a longer period of time.” A possible recession, which many had predicted for the latter half of 2023, hasn’t necessarily been dodged, he said, but now might be a “back-end 2024 problem.”

Without mentioning Medicare, Medicaid or Social Security once during his nearly hour-long interview, Ryan might have made some listeners uneasy with his allusions to slowing spending on them.

“If you want to get at the debt crisis, you have to address healthcare entitlement spending. If you want to successfully address healthcare entitlement spending, you have to bring market forces to help bring the costs down,” Ryan said. With a jump from 40 million retirees to 77 million “in one generation,” he said the costs of those programs sustain a “debt crisis.”

Ryan said Minnesotan Rep. Tom Emmer was “most qualified” to become his party’s next nominee to fill the long-vacant House Speakership. Hours later ,Emmer was chosen but then quickly withdrew.

Ryan said that whoever does become the next speaker could have an even shorter tenure than the recently deposed Kevin McCarthy (D-CA). A key reason is the high-pressure dealmaking that may need to be done with spending bills. Ryan predicted another continuing resolution in November would allow the country to run into December, when a shutdown and the loss of another House Speaker could become all the more likely.

Read additional coverage of Ryan’s talk in sister publication McKnight’s Senior Living.