Illustration: Gabriella Turrisi/Axios
Lobbyists and congressional staff have had preliminary discussions about reversing President Biden's nursing home staffing rule to generate billions in savings to help pay for a year-end health care deal, sources say.
Why it matters: CBO says reversing the rule would save $22 billion over 10 years, likely more than enough to cover a range of health extenders, though many unknowns remain.
What we're hearing: The discussions are only for the scenario in which former President Trump wins the White House. The speculation is that Democrats then might go along with reversing the rule, reasoning that Trump would scrap it anyhow and that the savings might as well be used on something.
- But that's far from assured.
Catch up quick: The Biden administration rule would set minimum staffing standards for nursing homes, including 33 minutes of care per patient per day from a registered nurse.
- Supporters say the mandate is needed to ensure that seniors are receiving adequate care and not waiting long periods to get help.
- "The quality of care in facilities for residents has just been really, really substandard for so long, and a lot of that has been tied to low staffing levels," said Priya Chidambaram, senior policy manager at KFF.
The other side: Republicans and a handful of Democrats say the staffing standard will be practically impossible to meet and could force nursing homes to close, especially in rural areas.
- The nursing home industry has also been lobbying forcefully against the rule — another factor that could put a rollback in play as a potential payfor.
- "This impossible mandate threatens access to care for seniors across the country, and we urge members of Congress to take action," said Clif Porter, senior vice president of government relations at the American Health Care Association, which represents nursing homes.
The big picture: It is not clear that Congress will need this offset to pay for items like extending telehealth flexibilities or community health center funding, given that there are already a range of payfors around PBM changes and Medicare hospital outpatient costs.
- But if opposition from the PBM and hospital industries makes those policies radioactive, it's certainly possible that lawmakers would look for other options that are politically more expedient.
