Illustration: Natalie Peeples/Axios
Senate Republicans' "skinny" budget plan is light on health care payfors. But it has one prominent feature: It assumes a rollback of former President Biden's nursing home staffing rule.
Why it matters: Killing the staffing standard would generate only a fraction of savings needed to pay for the $300 billion package but would benefit long-term care providers who say it's excessively burdensome amid a health worker shortage and would weigh heaviest on rural facilities.
Driving the news: Senate Finance Chair Mike Crapo said during last week's markup of the chamber's budget resolution that the rule "threatens patients' access to long-term care" in outlying areas.
- "Not only will this effort provide savings for our shared priorities in this legislation, but it will also serve as a commitment to reform our broken health care system," Crapo said.
- But he added that it would be the Finance Committee's only focus for health care and vowed that lawmakers were not intent on "opening up the tax bill or other issues or other efforts to try to reform other parts of our health care system."
Catch up quick: The Biden administration issued a final rule in April that established the first-ever nationwide minimum staffing requirements in nursing homes.
- It required facilities to provide 33 minutes of care per patient per day by a registered nurse. An RN also had to be on-site 24 hours a day.
- The requirements were due to be phased in starting in 2026, with rural facilities getting an extra year. But industry groups have sued to halt the process.
The other side: Senate Finance Ranking Member Ron Wyden told Axios on Tuesday that he thought overturning the rule would "take the nurse out of nursing homes" and have "enormous ramifications."
- "The rural language basically gives an exemption for years and years, so this is like a statement that they just don't want it," Wyden said.
By the numbers: The CBO estimates that rescinding the rule would result in $22 billion in savings over a decade.
- The Senate's budget resolution is much smaller than the House's, with $300 billion for immigration, the military and energy policies.
- Meanwhile, the House is aiming for a much more ambitious package that could require as much as $2 trillion in mandatory spending cuts.
Flashback: Although House Republicans have been more focused on Medicaid overhaul in their budget resolution process, both Ways and Means and Energy and Commerce approved legislation in the last Congress that would have reversed the nursing home rule.
- The House Budget Committee has also listed overturning "major Biden health rules" as one of the potential payfors in its "menu of options" documents that have been circulating.
What they're saying: "We greatly appreciate Chairman Crapo's leadership on this issue," Michael Bassett, senior vice president of government relations at the American Health Care Association/National Center for Assisted Living, told Axios in a statement.
- "We are encouraged that Congress will soon work to overturn this unrealistic rule. However and whenever this rule is defeated, we must focus on advancing more meaningful workforce solutions," he added.
- The group has pushed against the regulation since it was issued and sued the Biden administration over it.
What we're watching: How the dueling budgets play out, and whether rescinding this nursing home rule is an appealing-enough savings target to make it into any final package.
- President Trump indicated Wednesday morning that he's more supportive of the House's budget resolution, so it's possible the Senate's efforts could fall apart.
