A day after President-elect Donald Trump claimed a surprisingly decisive victory, many long-term care stakeholders were looking forward to sweeping policy changes. But some experts also warned Wednesday that the Trump win will cut both ways.
Providers hope to seize on Trump’s anti-regulatory outlook, reverse the Biden administration’s onerous new staffing requirements set to go into effect starting in 2026 and undo current opposition to for-profit nursing home ownership.
“Certainly, as in keeping with other Republican administrations, this will be more favorable if you’re an owner or operator of a skilled nursing facility or a chain,” said Fred Bentley, managing director for Medicare innovation at ATI Advisory. “The staffing mandate is dead on arrival. They will be scaling back or decreasing regulatory scrutiny, surveys. You can kind of go down the line, and it will be a more favorable environment.”
Still, years of work toward immigration reform needed to boost the long-term care workforce won’t even be open for debate under the next president, Bentley told McKnight’s Long-Term Care News. Also likely gone are tougher rules for Medicare Advantage plans, which have increasingly denied access to post-acute care.
Trump’s win and the Republicans’ take-back of the Senate may give the party a clear path to enact significant changes. The only major questions that remained unanswered by late Wednesday afternoon were how big the party’s majority would be in the Senate, and whether Republicans might also maintain control of the House of Representatives.
LTC advocacy groups weigh in
Clif Porter, president and CEO of the American Health Care Association/National Center for Assisted Living, said he welcomed the opportunity to work with Trump in a statement issued Tuesday.
“It is critical that our nation’s leaders prioritize, support, and invest in America’s seniors and their caregivers,” Porter said, inviting collaboration with Trump and the 119th Congress to address quality care and the growing caregiver shortage, and advocate for the nations’ aging population.
“While we are eager to get to work, there is still much that can be accomplished before the end of the year,” Porter added. “We urge lawmakers to pass legislation during the lame-duck session that rationalizes regulations, expands workforce development, and increases access to care for seniors and individuals with disabilities.”
Providers view the lame-duck session — the post-election period running from now through Inauguration Day on Jan. 20 — as an opportune time to tap outgoing members of Congress for support on issues they may have avoided previously. It can also be a chance for those leaving to force through reforms that didn’t get a vote earlier in the session.
Sen. Jon Tester (D-MT), for instance, championed legislation blocking the Center for Medicare & Medicaid Services nursing home staffing rule. He was voted out of office Tuesday, but LTC advocates believe Tester and others could still have major influence on the rule and other bills in the final days of the 118th Congress.
“We are optimistic that a Trump administration would rescind the unrealistic staffing mandate, but there are still multiple paths for Congress and the courts to address this issue as well,” Porter told McKnight’s. “We will continue to pursue all angles to protect access to care and push for more meaningful workforce solutions.”
Linda Couch, senior vice president of policy for LeadingAge, said if no lame-duck activity overrides the staffing mandate, the Trump administration could decide to suspend implementation and issue a final rule repealing it.
“We do see that action as a possibility; however, we will continue our legal advocacy unless or until any agency repeal is issued,” she told McKnights in an email.
Efforts also are already underway to understand what the new administration might focus on first — and to help land some skilled nursing and other LTC initiatives high on that priority list.
“Near-term, we will focus on working with the Trump transition teams to share LeadingAge’s agenda and to gain a clear understanding of the new administration’s housing, aging, health- and long-term care goals,” LeadingAge President and CEO Katie Smith Sloan said Wednesday. “As we learn more, we’ll have a better understanding of their potential impact on our members and those they serve — wherever they call home. That’s our top priority in the short term.”
Previous record
During his first day of the presidency in 2017, Trump used a common chief executive’s maneuver and ordered a freeze of all pending regulatory actions. That could be a go-to in his second term, too.
As of Wednesday afternoon, several rules that could affect post-acute care providers were still being reviewed by the White House Office of Management and Budget. Among them were five CMS rules, including a proposal that would govern policy and technical changes to Medicare Advantage and PACE programs in 2026. There are another six pending Department of Labor rules, including proposed updates to the Fair Labor Standards Act and a finalization of a rule to limit COVID exposure among healthcare staff.
Any rule still on that list come mid-January could be permanently frozen, and any finalized before then could be subject to Congressional Review.
“If the new administration is serious about reducing regulation and burden, there is plenty of that in healthcare,” Dan Mendelson, CEO of Morgan Health and founder of Avalere Health wrote on LinkedIn Wednesday.
It’s unclear whether Trump would go so far as to kill Biden-era rules that aimed to increase transparency into nursing home ownership, and give state licensing boards and others more quality information that could be used when considering future transactions.
Provider advocates, however, fully expect Trump will pull back on the rhetoric and foster a much-more hospitable environment for healthcare mergers and acquisitions.
“There was a cruelty with which President Biden maligned the nursing home sector,” Brendan Williams, CEO of the New Hampshire Health Care Association, told McKnight’s Wednesday. “President-elect Trump possesses no such animus toward the sector, and I expect his administration to pare back Biden’s bizarre regulatory vendetta.”
Mendelson said he expects “a more permissive deal environment, and increased deal activity in healthcare.”
One big determinant in how much unraveling Trump might do of M&A barriers is whom he taps as his secretary for the Department of Health and Human Services. The president-elect has said one-time Independent candidate and vaccine conspiracist Robert F. Kennedy Jr. will have a “big role” in his administration’s healthcare arm, with sway over food and drug regulation. Trump has not indicated whether that might be as an adviser or in a more official capacity.
Williams said he is “very uncertain” how Kennedy’s promised role would interact with the post-acute sector, which has seen both its workforce and residents largely reject COVID vaccines this fall.
Medicare and MA expectations
Because Trump campaigned on protecting Medicare and the nation is rapidly aging, Bentley predicted Trump could break on this issue with typical Republican expectations.
“I don’t get the sense that the budget hawks are coming after Medicare. Maybe they’ll try to come after Medicaid and trim the sails on Medicaid spending, and that could have adverse effects,” he said. “But it seems like the spigot is going to be wide open.”
That would include more favorable reimbursement for Medicare Advantage insurers, Bentley predicts, which plans could (or could not) pass on any gains in the rates they pay to skilled nursing providers. But Bentley warned, that “cuts a lot of different ways.”
“The extent to which the Biden administration was focused on improving access to skilled nursing care and home health services and requiring MA plans provide the same level of access and coverage that Medicare fee-for-service beneficiaries get, that’s gone or significantly watered down,” Bentley observed.
Big budget questions
Larger questions about how Trump approaches federal budget negotiations could also hang heavily over the sector. Congress still needs to pass another short-term government funding bill in December to avoid a shutdown.
“There’s motivation from both sides of the aisle to prevent a government shutdown. Budget concerns are legitimate for healthcare providers, but also for all industries,” added Melissa Schakowsky, director of government affairs at the Ambassadors Group, an advocacy organization for long-term care providers. “It’s also unknown how emboldened conservatives will be in trimming government spending, especially for entitlement programs.”
Couch said the big question is what happens with the House’s power balance.
“The answer could directly impact Congress’ appetite to tackle and ability to finish its FY25 bills, which we want them to do as quickly as possible,” she explained. “Continuing resolutions are not helpful for the programs or for the agencies, longer-term CRs especially so. If all of FY25’s work is punted to the next session, these bills could get tangled with decisions around raising the debt ceiling and other very sticky wickets.”
And what happens in future, full-year budget processes also could spell bad news for patients and providers.
Some Republicans have pushed for across-the-board spending reductions that would drive down healthcare spending. While some settings can rely on insurance companies and private pay to boost their bottom lines, skilled nursing providers are almost predominantly dependent on Medicare and Medicaid payments.
Trump has proposed that his confidant Elon Musk join his cabinet as “secretary of cost-cutting;” Musk has said he wants to eliminate $2 trillion from the federal budget.
Williams said Wednesday he hopes no Musk proposals emerge “that would injure Medicaid and Medicare.”
