Ahead of Tuesday’s presidential election, the two leading candidates appear to share some common ground regarding overall support for long-term care, including nursing homes, and their commitment to Medicare. However, a deeper look at their positions reveals differences that could, according to some, lead to changes in the nature of the Medicare program over time.
Trump’s focus is largely on incentivizing at-home care and supporting family caregivers, albeit with a more hands-off regulatory approach and tax cuts, which raises worries about the quality of care. In contrast, Harris’ policies prioritize expanding access to comprehensive home care services, pushing for minimum staffing in nursing homes and greater transparency of ownership, while also raising concerns about overregulation.
These differences reflect broader ideological divides, with Harris advocating for a more involved role for government in the long-term care sector, while Trump’s approach leans toward deregulation and individual responsibility.
Both approaches have their critics and supporters in the industry. That said, advocacy groups have been able to find a way to work with all.
“Whether it’s Republicans or Democrats, we will work with them,” Katie Smith Sloan, president and CEO of LeadingAge, told Skilled Nursing News. She stressed the importance of a fair balance of power on all levels of government as that has always been important for favorable policies on nursing homes, adding, “So much depends on where the leadership is at the cabinet level, who’s the head of HHS, CMS.”
Harris’ recent proposal for in-home care generated much talk in the sector, and it seems to have support among skilled nursing providers, who don’t believe that the need for SNFs will ever go away.
“If you can bring care to their home with the reimbursement system and other mechanisms in place, I think it’s great. I hope they expand [in-home care],” Craig Abbott, president and CEO of Saint Therese, told SNN. “But you can only do so much care and service in your home.”
Also among the issues that will be top of mind for nursing home providers amid a flurry of mergers and acquisitions in the sector this year is the transparency of ownership.
Harris is likely to back one of the cornerstones of the Biden-Harris Administration’s policy for greater scrutiny on ownership structures in nursing homes and a bid for more transparency and the role of private equity. After all, President Joe Biden mentioned SNFs specifically in 2021 in his State of the Union speech, promising that the practice of Wall Street firms buying up nursing homes would end on his watch. However, for a better part of his tenure, federal officials failed to provide clarity on various ownership structures they hoped to scrutinize until more recently, with its transparency rule. Given the rule, the bid for transparency will surely be a policy that will continue with a Harris administration, with the Centers for Medicare and Medicaid Services (CMS) requesting more inquiry into ownership through the off-cycle revalidation for nursing homes beginning this fall.
Meanwhile, Trump doesn’t seem to prioritize transparency or explore the role of private equity, judging by the policies of his previous administration and those of his former CMS chief, Seema Verma. Verma was highly critical of minimum staffing requirements and took aim at private equity ownership, among other initiatives included in Biden Administration’s reform plan.
Donald Trump’s Policies versus Kamala Harris’ Vision on Long-Term Care
Donald Trump’s overall approach to long-term care centers on a few key initiatives aimed at protecting seniors and promoting at-home care. He proposes to shift resources back to at-home senior care, addressing workforce shortages by supporting unpaid family caregivers through tax credits. However, his administration has faced criticism for relaxing oversight in nursing facilities. For instance, regulations were issued to remove the requirement for nursing homes to employ infection preventionists, potentially jeopardizing resident safety. Additionally, routine inspections in nursing facilities were suspended during the early months of the COVID-19 pandemic, raising concerns about care quality and oversight.
To address the immediate needs of seniors during the pandemic, Trump launched the Pharmacy Partnership for Long-Term Care Program to facilitate COVID-19 vaccinations for residents aged 65 and older. However, he also issued guidance to delay the implementation of the “Settings Rule,” which aimed to enhance protections for individuals using Medicaid home and community-based services (HCBS).
In contrast, Kamala Harris’ long-term care policies emphasize expansion and support for home care services. She proposes enhancing Medicare to cover a broader range of home care services for individuals with functional or cognitive impairments, funded through expanded Medicare drug negotiations and other measures. Harris advocates for partnerships with private technology companies to improve remote patient monitoring and telehealth, as well as to bolster the home care workforce.
A significant aspect of her platform includes efforts to end Medicaid estate recovery—a practice where states recoup Medicaid long-term services and supports (LTSS) costs from the estates of deceased enrollees. Harris plans to work with Congress or use administrative measures to broaden exemptions for families, alleviating some financial burdens on caregivers.
Under the Biden-Harris administration, new reporting requirements for COVID-19 vaccination rates in nursing facilities were implemented to enhance transparency and accountability. The Biden-Harris administration also established minimum staffing requirements for nursing facilities, alongside initiatives to support nursing facility workers and increase transparency regarding private equity ownership of these facilities.
The staffing rule remains highly unpopular within the industry, and already efforts underway to defeat it.
Positions on Medicare Advantage
The ongoing debate between former President Trump and Vice President Harris shows them positioning themselves as defenders of Medicare, with each accusing the other of endangering the program. A key aspect of their debate is the future of Medicare Advantage, a private insurance alternative that now covers over half of Medicare beneficiaries.
Should Trump win, it’s projected that enrollment in these plans could significantly increase, according to KFF news, as he and his Republican allies push to make Medicare Advantage the default option for new beneficiaries. This shift could lead to a privatization of Medicare, as beneficiaries often remain with their initial plans.
Supporters of Medicare Advantage argue that it offers enhanced benefits and lower out-of-pocket costs, eliminating the traditional 20% coinsurance. However, critics warn that increased insurer control has restricted access to care in imposing administrative and financial burdens on facilities with excessive denials, especially through the problematic prior authorization process. Moreover, traditional Medicare, which provides broader access to providers, could suffer as more beneficiaries gravitate toward MA plans.
The transition to Medicare Advantage gained momentum from 2003 legislation under the Republican Administration of George W. Bush, who expanded the role of private health plans. Lawmakers anticipated that private insurers would effectively manage costs. However, these plans have proven to be more expensive, the KFF article states. And two decades later, Medicare Advantage plans cost the government and taxpayers approximately 6%, or $27 billion, more than traditional Medicare, despite some studies indicating they offer improved care.
For its part, during the annual open enrollment period, the Trump administration actively promoted Medicare Advantage through emails, and support for these privately managed plans has since garnered bipartisan backing as their enrollment has increased.
While both candidates propose expanding Medicare benefits, less attention is given to the implications of privatizing the program. Past legislation has already facilitated the growth of Medicare Advantage, resulting in increased costs for taxpayers despite claims of better care.
And whether the election brings drastically different policies or not, removing the hurdles from Medicare Advantage remains a key concern of advocacy groups.
“There’s so much money going into managed care, for so many more people enrolled in managed care, that we can’t ignore it,” said Smith Sloan, who added that LeadingAge will certainly continue its push for greater scrutiny on Medicare Advantage plans and their prior authorization process.
“How quickly [change] happens, I have no idea. But I do think there are people in Congress [who recognize that] the problem needs to be solved through changes in policy,” she said.
