In 1990, Sen. Jay Rockefeller (D-West Virginia), in introducing the report of the U.S. Bipartisan General Health Care Commission (also known as the “Pepper Commission”) to Congress, wrote that regarding long-term care, “the established system of private insurance cannot be threatened by government expansion, and insurance providers can benefit significantly from widespread public support.”
Unlike the committee's health care reform proposals, the committee's long-term care proposals received bipartisan support from committee members, including that the federal government pay for home health care and the first three months of a nursing home stay, and for long-term nursing home care that would otherwise deplete residents beyond their “bed of protection” and deplete their personal assets.
Of course, nothing came of these recommendations. Just as the National Long-Term Care Commission's 2013 report to Congress yielded nothing lasting, the Coronavirus Commission's 2020 report on Nursing Home Safety and Quality yielded nothing lasting.
In the absence of a national long-term care policy, states and health care providers are left to fend for themselves. I have fought for Medicaid shortfalls in two different states.
In 2003 and 2004, when I was the youngest state executive at the time, the Washington Medical Association had to block budget cuts from a Democratic governor that were supported by the Democratic House of Representatives. For example, in 2003, the weighted average rate of $131.57 drops to $127.45. Republican Senate support and a new provider tax could raise that amount to $144.54. The following year, Senate Republicans again overwhelmingly defeated House Democrats and added another increase.
But our success came with immense stress. So, for reasons I can't remember now, I chose to leave my WHCA role by becoming a state representative and replacing one stressful existence with another. I was 36 years old, so I don't think I understood it very well.
I've been thinking about my experience in Washington recently for two reasons.
First, my longtime predecessor who hired me as an attorney at WHCA recently passed away at the age of 81. It is because of Gerald “Jerry” Riley that I am in long-term care to this day. He was only 57 years old when he left the WHCA, tired of fighting Medicaid and a state agency that was highly hostile to facility-based care. I say “only” because I'm currently 57 years old.
Second, after nearly a decade in New Hampshire, he is once again facing attrition. Like Idaho, which resulted in a 4% Medicaid cut, our state has been overzealous in cutting taxes. This led to a frightening budget session that saw, among other things, a 17.6% cut to the nation's most underfunded university system. Funding for nursing homes increased, but it turned out that the July 1 rate hike could not be maintained. Instead, we found that interest rates fell by an average of 3.91% in November.
Although we secured accommodative funding transfers to avoid net reductions after invoking the PR nor'easter, many facilities will still see significant reductions due to their unique interest rate methodology. The 2026 legislative session faces the daunting task of finding the money to avoid a shutdown in the second-most populous state amid dire revenue conditions.
The extreme anxiety of our members is a harrowing reminder of my days in Western Washington. This confirms the fact that in so many states, every budget cycle is a struggle for survival to provide some measure of civility and humanity to the most vulnerable citizens and those who care for them.
You can't blame your friends for selling their facilities or resigning from national leadership positions. Because this is a soul-crushing struggle. And, sadly, the struggle never ends.
Brendan Williams is president and CEO of the New Hampshire Health Care Association.
Opinions expressed in guest posts for McKnight's Long-Term Care News are those of the author and not necessarily those of McKnight's Long-Term Care News or its editors.
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