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 Split Election Results Impact LT/PAC, Medicaid Reform Fades as Issue

Democrats will control the House of Representatives for the first time since 2010 and Republicans expanded their Senate majority after voters on Nov. 6 rewarded both parties with positive results to talk about in what was a hotly contested mid-term election with high voter turnout and deep implications for the 2020 presidential and congressional votes to come. 

The impact a divided Congress will have on the long term and post-acute care (LT/PAC) profession remains to be seen, but the major issue of Medicaid reform should be effectively squelched with the Democrats taking control of the House, says Clifton Porter II, senior vice president of government affairs for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

“As it relates to health care in the House, and frankly every big issue in the House, it is going to be about the Democrats drawing a bright line between their vision and the vision of this administration. So, I would anticipate a lot of activity around the Affordable Care Act [ACA], and obviously not a lot of activity around Medicaid, particularly as it relates to changing the benefits in a manner that was attempted by Republicans in 2017. I feel good about that,” he says.

Last year, Republicans failed to muster enough votes even when they controlled both houses of Congress to pass an ACA repeal and replace package. The legislation included reforms to the Medicaid program that would have instituted a massive overhaul of Medicaid’s traditional funding mechanism through the use of block grants to the states. 

As for how the election results will affect other hot-button issues for LT/PAC providers, Porter says the regulatory front should not be impacted. “I think CMS [Centers for Medicare & Medicaid Services] is going to continue on. This administration is not going to be taking any signals from a Democratic House at all. I think the agenda remains the same,” he says. This includes the Oct. 1, 2019, implementation of the new Patient-Driven Payment Model that providers are preparing for and the continued rollout of new Requirements of Participation. 

There are, however, potential larger matters that Congress may undertake on a bipartisan basis, but how that plays out amid the other major priorities for new House leadership is something to watch for in the coming weeks and months. “I do think as it relates to our potential issues we have to ask will our issues elevate above the noise in light of all the other issues that Democrats want to attack the president on,” Porter says. While Democrats have traditionally looked to regulate the LT/PAC profession in any number of areas, “I am having kind of a hard time thinking at least over the next two years, particularly in light of the fact that we are entering a presidential election cycle, that we will have any significant focus on our [regulatory-related]  issues.”

One topic that may be addressed in the House and Senate is immigration, which Porter says is important to providers during a time of extreme workforce challenges. “One of issues that Democrats are concerned about is immigration. And, there may be a path for doing something on immigration,” he says. “And, if there is that could have a positive impact, at least on the potential supply of workers because that is a huge issue for our operators out there in the field. So, I am optimistic there may be some room for some bipartisanship on important issues to us, with immigration being a key one.” 

As for how the profession will manage the process of getting to know what amounts to dozens of new members of Congress, Porter says the good news for AHCA/NCAL “is a lot of the new folks are not necessarily new to our members. These are folks who have emerged in many cases from the local political arena.”

New chairs of the key committees in the House are also not strangers to the profession, he says, pointing to the longstanding relationship AHCA/NCAL has with the expected incoming House Ways and Means Committee Chair Richard Neal (D-Mass.) as just one example. Porter does note that just as many eyes will be on who Democrats choose for their leadership slots, like for House Speaker, which he believes will go to current Democrat Leader Nancy Pelosi (D-Calif.), there is also a lot of focus on who Republicans select for any number of openings on key health care-related committees.

Overall, in summation of the mid-terms, there was no real shock with regard to the resulting divided Congress, even if the nuances of the votes were not always expected, he says. “In the House, the suburban part of America basically repudiated the Trump agenda and in many cases those races were called as a result of a sort of position against Trump,” Porter says. “I think in the Senate it was a pleasant surprise for Republicans. As it stands right now they have 52 seats locked. Mississippi, Montana, and Arizona are still outstanding so the fact that Arizona and Montana remain competitive could put the count to as high as 54 or 55, and that would be a really strong night for Republicans in the Senate.”
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