The Trump Administration’s Impact on LTC

In most cases, past actions are excellent predictors of future performance. Thus, in order to gain insights into the probable impact of President Donald Trump’s administration on long-term care (LTC), we should begin by examining the professional and personal history of the administration’s major players.

We know that, as a congressman, the new Secretary of Health and Human Services (HHS) Tom Price, MD, sponsored legislation HR 2300, known as the Empowering Patients First Act,¹ which provides tax deductions and credits for health insurance, promotes state-based, high-risk insurance pools, and allows for interstate insurance markets among other things; the Act intends to fund itself through cuts to future spending increases. We also know that the new Centers for Medicare and Medicaid Services (CMS) Administrator, Seema Verma, MPH, led the Healthy Indiana Plan (HIP), “a health insurance program from the state of Indiana that pays for medical expenses and provides incentives for members to be more health conscious. HIP 2.0 provides coverage for qualified low-income state residents who are interested in participating in a low-cost, consumer-driven health care program.”² These professional endeavors provide some insight into their ideas on health care reform, but evidence of President Trump’s opinions and positions on these topics are less discernible.

Perhaps a clue can be gleaned from some of his personal experiences in the area of senior care. President Trump’s parents both lived well past the age of 85, so he should be familiar with the trials and complexities of caring for aging parents. Indeed, his father, Fred, died at the age of 93 years from pneumonia after suffering from Alzheimer’s disease (AD) for 6 years. With this background, it should come as no surprise that President Trump has spoken of AD as one of his top priorities. 

Moreover, at age 79 years, his mother, Maryanne, was robbed and beaten near her home in Queens, NY. She sustained broken ribs, facial bruises, several fractures, a brain hemorrhage, and permanent damage to her sight and hearing. She passed away several years later at age 88 years. This experience likely influenced his declarations regarding the need to protect older adults against abuse.

In 1975, President Trump’s parents donated to the construction of a skilled nursing facility (SNF) that now bears their name, Trump Pavilion for Nursing and Rehabilitation, and is described as a 228-bed, state-of-the-art facility providing an array of comprehensive services for short-term care, including rehabilitative, medical, and social services.³ Despite the creation of this SNF, President Trump himself seems to believe most seniors desire to age at home and has stated that home care should be a priority in public policy. This policy, as well as policy governing LTC, is likely to be left in the hands of state government, as his nominees for HHS and CMS believe in shifting funding and regulation from the federal to state government. Further, some of the groups responsible for creating federal policies for LTC have already been targeted for reductions or eliminations such as the Center for Medicare and Medicaid Innovation, Agency for Health Care Research and Quality, and Patient-Centered Outcomes Research Institute. 

With states left to decide their own courses of action for LTC, we are likely to see a range of varying strategies. Some states will pursue creative solutions in order to deliver better, less expensive care for their citizens through such programs as the Program for All-Inclusive Care for the Elderly (PACE)⁴ and paid caregiver programs. Other states may simply view this power as an opportunity to save money by spending less on the care for their most needy residents through decreasing reimbursement to SNFs. As a result, the management of LTC will not have a common direction as it would have if federally regulated, and, in the coming months, state professional associations will be best positioned to provide guidance rather than national associations.

Given this current shift to deregulation, the SNF penalties, which are set to begin on October 1, 2017, may be delayed. Penalties are in place related to the following quality measures: (1) functional status/cognitive function, (2) skin integrity, (3) incidence of major falls, (4) spending per beneficiary, (5) discharge to community, and (6) preventable hospital readmissions. Additional delays may be caused by the “brain drain” that commonly occurs as current staff aligned with the previous administration leave HHS and CMS rather than work under a new administration. 

But, despite the possibility of a delay, SNFs would be well served to continue to focus their attention on improving in these areas, as their referrals from hospitals and directly from patients and their families are often based on their performance on these same measures. The bottom line is that the delivery of high-quality care will always be in high demand, even if it is not federally mandated. Nuances of LTC delivery strategies will merely vary greatly from state to state. 

1. Empowering Patients First Act of 2015, HR 2300, 114th Cong, (2015-2016). http://tomprice.house.gov. Accessed January 10, 2017.

2. City of Bloomington, Indiana government. Health Indiana Plan – Health Insurance for Adults. The City of Bloomington, John Hamilton, Mayor website. bloomington.in.gov/documents/viewDocument.php?document_id=2334. Accessed January 10, 2017.

3. Trump Pavilion for Nursing and Rehabilitation. Trump Pavilion website. http://trumppavilion.org/. Accessed January 9, 2017.

4. Program of All-Inclusive Care for the Elderly. Medicaid.gov website. https://www.medicaid.gov/medicaid/ltss/pace/index.html. Accessed January 9, 2017.