Skip to main content

The GOP Agenda: Worse Care, Higher Costs for Residents at Nursing Homes

By March 5, 2019No Comments

Washington, DC — Ahead of the Senate Finance Committee’s hearing on nursing home neglect and abuse tomorrow, it’s important to remember just how the GOP’s health care policies have failed nursing home patients across America. Donald Trump and his Republicans in Congress worked to repeal the Affordable Care Act, block expansion and access to Medicaid, and fell into lock step with the nursing home industry to weaken penalties they may face for harming their own residents. The GOP Agenda has nothing to do with helping those in nursing homes and long-term care facilities–it only seeks to serve industry CEOs and gut access to care so many patients desperately need.

The GOP Agenda: Repeal the Affordable Care Act and Its Protections for People in Nursing Homes

The ACA Expanded Nursing Home Quality-Related Requirements for the First Time Since 1987. “The Affordable Care Act (ACA) is the first comprehensive legislation since the Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87), to expand quality of care-related requirements for nursing homes that participate in Medicare and Medicaid and improve federal and state oversight and enforcement…the ACA incorporates the Nursing Home Transparency and Improvement Act of 2009, introduced because complex ownership, management, and financing structures were inhibiting regulators’ ability to hold providers accountable for compliance with federal requirements. The ACA also incorporates the Elder Justice Act and the Patient Safety and Abuse Prevention Act, which include provisions to protect long-term care recipients from abuse and other crimes.” [Kaiser Family Foundation, 1/28/13]

The GOP Agenda: Cutting Access to Nursing Home Care by Slashing Medicaid

Medicaid Pays for Most of the 1.4 Million People in Nursing Homes. “Medicaid pays for most of the 1.4 million people in nursing homes… It covers 20 percent of all Americans and 40 percent of poor adults…A combination of longer life spans and spiraling health care costs has left an estimated 64 percent of the Americans in nursing homes dependent on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the primary payer for three-quarters or more of nursing home residents in 2015, according to the Kaiser Family Foundation.” [New York Times, 6/24/17]

Medicaid Covers 6 in 10 Nursing Home Residents, and Half of Seniors Using Medicaid Long-Term Care Services Were in Nursing Homes. [Kaiser Family Foundation, 6/20/17]

The Trump Administration and Republicans in Congress Pursued ACA Repeal Bill that Would Have Also Slashed Medicaid. “On Thursday, Senate Republicans joined their House colleagues in proposing steep cuts to Medicaid, part of the effort to repeal the Affordable Care Act. Conservatives hope to roll back what they see as an expanding and costly entitlement.” [New York Times, 6/24/17]

New York Times Headline: “Medicaid Cuts May Force Retirees Out of Nursing Homes” [New York Times, 6/24/17]

Associated Press Headline: “Medicaid cut in GOP health bill worries the nursing home set” [Associated Press, 7/8/17]

Senate GOP Repeal Bill Would Have Cut Medicaid by $2.6 Trillion by Second Decade. “The Congressional Budget Office (CBO) estimates that the Senate Republican health bill’s Medicaid cuts would deepen significantly in the second decade, with the cuts growing from 26 percent in 2026 to 35 percent in 2036, relative to current law. Now, based on CBO estimates and data, the Committee for a Responsible Federal Budget (CRFB) estimates that the Senate bill would cut Medicaid by roughly $2.6 trillion over the second decade (2027-36), on top of Medicaid cuts of $772 billion in the first decade.” [Center on Budget and Policy Priorities, 7/11/17]

The Trump Administration is Looking for Ways to Bypass Congress to Enact Medicaid Block Grants. “The Trump administration is quietly devising a plan bypassing Congress to give block grants to states for Medicaid, achieving a longstanding conservative dream of reining in spending on the health care safety net for the poor…Capping spending could mean fewer low-income people getting covered, or state-designated cutbacks in health benefits.” [Politico, 1/11/19]

In 2018, the Trump Administration Proposed Cutting Medicaid by $1.4 Trillion. “The Administration is proposing to cap federal Medicaid payments to states and to cut federal Medicaid spending by $1.439 trillion – that is trillion with a “t” – over the ten year period 2019 – 2028. That is about 26% of what the Administration projects federal Medicaid spending would otherwise be, and within shouting distance of the $1.455 trillion cost of the tax cuts enacted in December.” [Georgetown Center for Children and Families, 2/12/18]

The GOP Agenda: The Trump Administration Weakened Penalties Against Nursing Homes that Harm Patients at the Request of the Nursing Home Industry

The Trump Administration Scaled Back Fines Against Nursing Homes that Harm Residents, at the Request of the Nursing Home Industry. “The Trump administration is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury, part of a broader relaxation of regulations under the president. The shift in the Medicare program’s penalty protocols was requested by the nursing home industry…The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities. [New York Times, 12/24/17]

New Guidelines Intended to Discourage Regulators from Levying Fines, Even When Violations Resulted in Resident’s Death. “The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities.” [Kaiser Health News, 12/31/17]

In November 2017, The Trump Administration Exempted Nursing Homes Violating Certain Rules from Penalties for 18 Months. “In November, the Trump administration exempted nursing homes that violate eight new safety rules from penalties for 18 months. Homes must still follow the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and to ensure that every home has adequate resources to assist residents with major psychological problems.” [New York Times, 12/24/17]

In October 2017, the Trump Administration Discouraged CMS Regional Offices from Levying Fines if the Error was a “One-Time Mistake.” “In October, CMS discouraged its regional offices from levying fines, even in the most serious health violations, if the error was a ‘one-time mistake.’ The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.” [Kaiser Health News, 12/31/17]
The Trump Administration Rolled Back Obama Administration Rule Making it Easier for Nursing Home Residents to Sue for Negligence or Abuse. “Another Obama-era regulation is on the Trump administration’s chopping block — this one about nursing homes. The Obama administration’s rule would’ve made it easier for nursing home residents to sue for negligence or abuse. But the Trump administration is proposing to replace that rule. And the new one could make it almost impossible for nursing home residents to get their day in court. That is because new nursing home residents are frequently handed an agreement to go to arbitration instead of suing if something goes wrong.” [NPR, 8/21/17]