‘Noble’ but a ‘Disaster’: Kennedy Raises Concerns About Practicality of Nursing Home Staffing Mandate

During a heated first confirmation hearing on Wednesday, Robert F. Kennedy Jr. raised concerns over the practicality of the nursing home staffing mandate, acknowledging the risks it poses to access of care, especially in rural communities. He also shared his vision for lowering overall health care costs.

Kennedy is seeking to lead the $1.7 trillion Department of Health and Human Services (HHS), which oversees a broad range of public health functions.

In his appearance before the Senate Committee on Finance, Kennedy called out the staffing mandate’s 24/7 registered nurse (RN) requirement, saying the rule would create hardships for nursing homes.

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Kennedy also highlighted value-based care, artificial intelligence tools and technology as well as telemedicine as means to bring down health care costs.

And on the issue of reforming Medicaid, for which House Republicans are proposing cuts to offset costs associated with lower taxes and border security, Kennedy simply said he wasn’t planning on “dismantling” the program. 

Staffing rule ‘noble’ but ‘a disaster’

The minimum staffing rule finalized by the previous Administration in May has been widely unpopular among nursing home providers. And, Kennedy’s responses indicate that he might support rescinding it, noting that its implementation would be particularly harmful to rural areas.

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“So the intention, although it was noble, was in reality, for rural areas at least … going to be a disaster,” Kennedy said.

The staffing rule’s minimum staffing requirements are not set to go into effect until 2026 for urban communities, and even later for rural communities.

Rural health care, in general, would be an area of focus for both Dr. Mehmet Oz – President Trump’s nominee to lead Centers for Medicare & Medicaid Services (CMS) as well, Kennedy said.

“Dr [Mehmet] Oz and myself recognize that rural health care is in crisis in this country, and that is catastrophic for our entire country,” Kennedy said.

Sen. John Barrasso (R-Wyo.) questioned Kennedy on addressing challenges like workforce shortages in rural areas that are pushing closures of hospitals and nursing homes, threatening access to health care, stating that the Biden Administration’s minimum staffing rule will be detrimental to continuity of nursing home care in rural states like Wyoming.

“It’s a rule that would triple the registered nurse requirements in nursing homes [and] there just aren’t enough registered nurses in our state to be able to comply with this,” Barrasso said. “This would lead to nursing home closures across our state. Will you commit to working with me to fix this serious problem?”

Kennedy agreed that implementing the minimum staffing rule will mean the closure of nursing homes in rural areas across the country.

“These are staffing rules that require 24-hour staffing by medical professionals. Some of the nursing homes in rural areas simply do not have the available personnel or the economics,” Kennedy said. “[This] means the parents, the elderly parents, will be moved a great distance from the local community and their family. And we know that the single greatest driver of high quality nursing home care is the proximity of family,” he said.

Medicaid, Medicare reform

Sen. Bill Cassidy (R-La.), a doctor by training, repeatedly pressed Kennedy on his plans for Medicaid, but Kennedy failed to provide a clear proposal.

To offset the costs of a massive party-line reconciliation bill, which includes tax cuts and ramped up border security, House Republicans are exploring over $5 trillion in potential cuts targeting various programs including Medicare, Medicaid, the Affordable Care Act (ACA), climate initiatives, and welfare. Around $2.3 trillion of these cuts are connected to Medicaid alone.

“Republicans are looking at ways to potentially reform Medicaid to help pay for President Trump’s priorities, but to [also] improve outcomes. What thoughts do you have regarding Medicaid reform?” Sen. Cassidy asked, urging Kennedy to address how he might make the program more cost efficient.

When Kennedy suggested a range of improvements based on making the program more centered on value-based care, increasing use of technology and telemedicine, Sen. Cassidy asked again, “What reforms are you proposing with these ideas, vis a vis Medicaid?”​​

“I don’t have a broad proposal for dismantling the program,” Kennedy said in response.

During the hearings, Kennedy also seem to make some factual errors, claiming Medicaid is fully funded by the federal government when it’s jointly funded by states and the federal government. Kennedy suggested privatizing these programs, claiming most Americans prefer private insurance over government-run plans.

Preference for Medicare Advantage

He also misstated the penetration rate of Medicare Advantage plans, saying that about half of Americans used these when only about 1 in 10 Americans are currently enrolled in MA plans. That said, Medicare Advantage plans are fast growing and Medicare Advantage enrollees do make up more than 50% of all Medicare beneficiaries in many states.

Moreover, Kennedy stated that MA plans are more sought after by consumers compared to Fee-for-Service (FFS) Medicare. In reality, however, due to the high rate of service denials and the problematic use of AI tools by insurance providers in MA plans, consumers are becoming increasingly wary of them.

Recently, expert analysis named Medicare Advantage as a major disruptor, especially in increasing costs and administrative burdens for the nursing home sector.

Nevertheless, Kennedy held a favorable view of Medicare Advantage.

“I think more people would rather be on Medicare Advantage because it offers very good services, but people can’t afford it. It’s much more expensive,” Kennedy said during the hearings.

To bring down overall health care costs, Kennedy said, “There are all kinds of exciting things that we can be doing, including cooperatives, which President Trump has supported, including health savings accounts, which President Trump has supported – all of these things to make people more accountable for their own health.”

Kennedy also faced tough questions on vaccines, denying he is anti-vaccine, but acknowledging he has raised “uncomfortable questions” about vaccines despite vaccinating his own children.

The second confirmation hearing will be held on Thursday before the Senate Committee on Health, Education, Labor and Pensions.

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