The fight over the White House’s plan to impose minimum staffing levels at nursing homes is escalating as the Biden administration seeks to avoid challenges in Congress and the courts.
On Capitol Hill, lawmakers from both chambers introduced joint resolutions under the Congressional Review Act (CRA) to overturn the rule.
The policy exposed a divide among Democrats, especially among frontline members from rural states.
The Senate measure, led by Sens. Jon Tester (D-Mont.), James Lankford (R-Okla.) and Joe Manchin (IW.Va.), has a significant chance of passing in the Democratic-controlled Senate.
A CRA resolution is not subject to the 60-vote filibuster and only needs a simple majority vote. If Tester, Manchin and all House Republicans vote in favor of the resolution, it will pass — although President Biden will likely veto the measure.
“At a time when nursing homes in Montana are facing labor shortages, it makes no sense for unelected bureaucrats in the Biden administration to establish a one-size-fits-all policy that would force these critical facilities to close their doors. That’s why I’m joining Republicans to end this rule,” Tester said in a statement.
Manchin, who is retiring, called the rule “overly demanding and unrealistic.”
Tester is running for re-election in a red state and is one of the Senate’s most vulnerable Democrats. He has been outspoken about the need to prevent the rule from taking effect.
Last fall, he and Manchin sent a letter to the Centers for Medicare and Medicaid Services (CMS) demanding that the agency rescind the rule.
That letter was signed by Democratic Senators Maggie Hassan (NH), Jeanne Shaheen (NH), and independents Kyrsten Sinema (Ariz.) and Angus King (Maine).
None of these senators spoke in favor of the CRA and their offices did not respond when asked if they supported it.
However, King recently joined Senator Kevin Cramer (R-N.D.) in expressing concerns about the mandate’s impact on veterans and asking the Department of Veterans Affairs to produce a report on the issue.
Senators argue the mandate will not solve labor shortages or quality of care issues and will force many rural nursing homes to close their doors.
In the House, a CRA resolution is supported entirely by Republicans. But Democratic Reps. Jared Golden (Maine) and Chris Pappas (NH) opposed the rule when it was initially proposed.
The arguments from both chambers echo industry groups that say any federal standard is unfeasible due to nationwide staffing shortages made worse by the pandemic.
Under requirements revealed in April, all nursing homes that receive federal funding through Medicare and Medicaid will have to have a registered nurse on staff 24 hours a day, seven days a week and provide at least 3.48 hours of care. of nursing per resident per day.
The rules will cost nursing homes $43 billion over the next decade, according to estimates from the Department of Health and Human Services (HHS).
President Biden, in his 2022 State of the Union address, announced a series of nursing home reforms and promised that minimum staffing would be among them. Advocates have pushed for such a requirement for more than two decades, arguing that residents are safer and get better care with more staff, but until now the industry has managed to successfully resist those efforts.
According to industry trade group American Health Care Association (AHCA), only 6% of nursing homes currently meet all four requirements of the rule.
David Grabowski, a professor of health policy at Harvard Medical School and an expert on the nursing sector, said the political backlash was “disappointing” to see.
“I never thought of the effort to improve the quality of nursing homes as a partisan issue, so I think measures to hinder high-quality care can also be bipartisan,” Grabowski said in an email.
He noted that the opposition from rural members is “misguided.” Rural areas have historically suffered from labor shortages, but the rule has specific exceptions and other protections for rural nursing homes.
For example, there is a longer ramp-up period for rural nursing homes to comply with the new rules. Additionally, the rule contains language that if rural nursing homes face a local labor shortage, they will be exempt from the policy.
Non-rural facilities must meet the requirements by May 2027, and rural facilities have five years, until May 2029.
“The new rule is far from perfect, but plenty of research supports the idea that many nursing homes in the U.S. often operate at levels that pose risks to the health and safety of their residents. I would have preferred to have seen members work to improve legislation to empower staff rather than work to tear them down,” Grabowski said.
But a congressional resolution is not the only threat to the new policy. A lawsuit filed by the AHCA in Texas asks a judge to overturn the rule.
The complaint argues that Congress never gave CMS the authority “to impose such onerous and unattainable mandates on virtually every nursing home in the country.”
The lawsuit was filed in federal court in Amarillo, Texas. Amarillo District Court has just one judge, Matthew Kacsmaryk.
Kacsmaryk, appointed by former President Trump, is the same judge who suspended approval of the abortion pill mifepristone and ruled against the Biden administration on several other issues, including immigration and LGBTQ protections.
This story originally appeared on thehill.com read the full story
