Election provides us new opportunities and some potential challenges

AHCA Member Call Scheduled for Friday, 11:30 am

Tuesday was an historic day.  Once again the voters shattered the conventional “wisdom” of D.C., and Donald Trump was elected the 45th President of the United States.  Very few in this town ever thought it would actually happen.  It was a complete repudiation of the status quo that brought other winners as well.  Republicans retained both the Senate and House, and in doing so are now in complete charge of both the executive and legislative branches.

What made this election different than any in my lifetime is the absolute certainty that each side had going into Tuesday: that the other winning would wreck the country.  This leaves the nation deeply divided and in need of healing and unity.  I have a view that is not widely held: the country would have been fine under either candidate.  We have survived a revolution, a civil war, a great depression, and two world wars.  It’s never, ever, smart to bet against the United States.

We will be fine and hopefully, prosper.  Similarly, the sector will be fine, but only if we make the right choices and do the hard work that our members and your residents and employees deserve.

I have already been contacted by members asking me what the election means for us.  This memo will provide a high level view.  We will be conducting a member conference call at 11:30 a.m. EST on Friday, November 11 to discuss further (call-in information can be found below).

Lame Duck -The first question we face is what will happen in the lame duck session of Congress.  The members return next week, and both houses will elect leaders for the next Congress and finish out this year.  I’ll start with the Senate because it’s pretty clear what will happen there.  The Republicans are very likely to re-elect Senator Mitch McConnell as their leader, and the Democrats are likely to elect Senator Chuck Schumer to replace Senator Harry Reid.  Senator Hatch is likely to continue to chair the Senate Finance Committee, and Senator Wyden will be the ranking Democrat.

The House elections are less clear.  Conventional “wisdom” is that Rep. Paul Ryan will be re-elected as Speaker.  There is a history between President-elect Trump and Speaker Ryan, so that is not certain but is likely.  Conventional “wisdom” also holds for now that the Democrats will re-elect Nancy Pelosi as their leader.  The chair and ranking members of Ways and Means are likely to continue to be Reps. Brady and Levin.  Less clear is the chair of Energy and Commerce, but Rep. Pallone will stay on as ranking member.

Also not clear is what else the Congress will try to do during the lame duck session.  We may have more clarity by Friday.  One option is to do almost nothing other than to pass the resolution needed to fund the government.  That is the likely scenario.  Also possible, but less likely, would be to pass a few bills such as the 21st Century Cures Bill.

The First 100 Days -This is where it gets really interesting and where there are some real opportunities and one big potential challenge.  Either way, we will work with the Board to determine our next steps.

Let’s begin with covering the opportunities.  One action the new Administration could take that would help us would be addressing the new Department of Labor overtime rule that changes the pay threshold to require more employees to be eligible for overtime pay.  There are guidelines on what a new president can and cannot do with respect to rules, and we are exploring all options surrounding the DOL issue.

We will also look closely at the CMS rules that have been issued in the last few months such as the Requirements of Participation and bundling.  We have heard from many of you regarding these onerous regulations, so we have them front and center on our radar heading into the new year.

Expect a lot of heated debate and calls for the repeal of Obamacare.  The best legislative option Republicans have is through reconciliation which requires only a simple majority in both the House and Senate.  Whether Republican leaders target some or all of the new law, we will be on the Hill ensuring that any congressional action is in your best interests.

It is in this reconciliation bill that we also face a huge challenge.  The likely plan will be to include Medicaid reform in the Obamacare repeal.  Initially, the talk was block grants.  Now, there is more talk of a per capita cap.  Either could cause us major problems, and we are currently working on a plan to shape them into programs that can work for us, or alternatively, trying to kill them altogether.  This could represent a major threat to the sector, and we will need your help on this issue.  We will be pushing out much more information on this later.

There are other areas we can predict and some we cannot.  In general, this lineup should be friendly to us on business/labor issues.  After our win on arbitration in the courts, we believed the plaintiffs lawyers would turn to Congress to succeed.  There is no way they can do this now.

President-elect Trump is new to the town in many ways and does not have a deep health care bench. We do have contacts through VP-elect Pence and our lobbying team, and we will hope to advise and shape those appointments.

It is an exciting time.  If we can emerge from these battles in good shape on the reimbursement side, and less burdened on the regulatory side, these can be great times.  It will take all of us pulling together and working hard to make that happen.

Thanks so much for your support.  We never take for granted the gift it is to be in this battle with you and for your residents and patients.

Best,

Mark Parkinson
President & CEO
AHCA/NCAL

Member Conference Call
Friday, November 11 | 11:30 am
Participant Access: 855.371.1642
Passcode: 246831