Tag Archives for LeadingAge

Trump’s Big Bill, Big Promises – But a Bust for Seniors

Pubished in Blackstone Valley Call & Times on July 8, 2025

After 48 relentless days of political maneuvering—marked by cajoling, backroom bargaining, strategic threats, and last-minute incentives to win over stubborn holdouts—President Donald Trump finally got his wish: Congress passed his prized “One Big Beautiful Bill” (H.R. 1), which he triumphantly signed into law on July 4, 2025.

On May 22, 2025, the House narrowly approved the sweeping 900-page bill by a vote of 215–214–1. Every House Democrat opposed the measure. Two Republicans, Reps. Thomas Massie (R-KY) and Warren Davidson (R-OH), joined the opposition, while Freedom Caucus Chair Andy Harris (R-MD) voted “present.” Two GOP lawmakers did not vote.

What’s In the Bill: Tax Breaks Up, Safety Nets Down

The legislation extends the 2017 individual tax cuts and adds new deductions for tips, overtime pay, auto loan interest, and “Trump Accounts” for children. It raises the SALT deduction cap to $40,000 for five years, increases the child tax credit, imposes a remittance levy, and taxes college endowment income.

On the spending side, H.R. 1 raises the debt ceiling by $5 trillion, slashes over $1 trillion from Medicaid and Medicare, expands work requirements for  Supplemental Nutrition Assistance Program (SNAP) recipients, and allocates $150 billion each to defense and border enforcement—boosting ICE funding to over $100 billion by 2029.

Senate Republicans spent more than five weeks reviewing the House bill’s provisions to comply with the Byrd Rule, walking a tightrope between deficit hawks and moderates. After a marathon “vote-a-rama” that saw 46 amendment votes (only six of which passed), the Senate approved the bill 51–50 on July 1, with Vice President J.D. Vance casting the tie-breaking vote.

The reconciliation process allowed the Senate to pass the bill with a simple majority rather than the standard 60-vote threshold. When the bill returned to the House Speaker Mike Johnson and President Trump personally lobbied holdouts, linking support to other legislative priorities and negotiating procedural rules. Early on July 3, the House adopted the Senate version in a 218–214 vote, with only Reps. Brian Fitzpatrick (R-PA) and Thomas Massie (R-KY) voting with Democrats. The bill was sent to the White House and signed into law the following day.

Despite Republican praise, public reaction to Trump’s “One Big Beautiful Bill” has been largely negative. A KFF Health Tracking Poll found that 64% of Americans view H.R. 1 unfavorably, compared to 35% in support.

President Trump and GOP leaders hailed the bill as a historic conservative win that fulfills “America First” promises—cutting taxes, slashing regulations, boosting border security, promoting energy independence, and reducing federal spending. “This is a major victory for hardworking families,” said Rhode Island GOP Chair Joe Powers in a statement, praising the bill for delivering middle-class tax relief and real border control.

But Congressman Gabe Amo (D-RI), representing Rhode Island’s 1st Congressional District, sees it differently and warns of the devastating consequences to aging programs and services.

“Trump’s big, ugly bill” shows that Republican lawmakers, following Trump’s marching orders, voted for “the largest theft in American history to further enrich the richest among us,” he says.

“Simply put, because of this horrific legislation, Americans will be poorer, sicker, hungrier, and further away from economic opportunity,” says the Rhode Island Congressman.

Deep Cuts and Dire Warnings from Aging Advocates

SACRI Policy Advisor Maureen Maigret emphasized the need for swift action in Rhode Island, stating, “It is crucial for the Secretary of the Executive Office of Health and Human Services to promptly convene the advisory group outlined in Section 8 of the state’s FY 2026 budget bill.”

“For years, SACRI has worked to ensure a balanced system of long-term services—supporting quality nursing home care, expanding access to affordable home and community-based services, and collaborating with the Office of Healthy Aging and other aging advocacy groups to promote healthy aging,” says Maigret.

SACRI, a statewide coalition advocating for older Rhode Islanders, has partnered with other organizations to make significant strides in these areas, according to Executive Director Carol Anne Costa. “We cannot allow this progress to be reversed, especially as older adults are the fastest-growing segment of the state’s population,” Costa says.

“We have sent a letter to Secretary Charest requesting that SACRI be included in the advisory group established by Article 8 of the state’s FY 2026 budget bill.”

Now accounting for nearly 20 percent of the total population, the number of Americans age 65 and older is steadily increasing.

“Make no mistake: this harmful, cold-hearted bill will wreak havoc on our country’s fragile aging services infrastructure—at a time when demand for the Medicare and Medicaid-supported services it delivers is growing,” warns Katie Smith Sloan, president and CEO of LeadingAge.

“This legislation deals a significant blow to a core element of our country’s social safety net: Medicaid,” adds Sloan, emphasizing that the consequences “will not be pretty.”

She further warns, “Due to the level of deficit this bill will create, Medicare payments to providers may be reduced by 4% for the next ten years.”

According to Sloan, the bandaids included in H.R. 1—such as freezing (but not reducing) nursing home provider taxes and creating a rural health transformation fund, both touted as protections for older adults and aging services providers—will soon prove ill-equipped to prevent the bill’s damage. As states begin to grapple with budget shortfalls caused by reduced federal Medicaid contributions, the suffering, she says, will begin.

Max Richtman, President & CEO of the National Committee to Preserve Social Security and Medicare, warned that 16 million Americans may lose health coverage, and millions more could lose access to food assistance. He stressed the bill’s devastating effects on the 7.2 million seniors dually enrolled in Medicare and Medicaid and the 6.5 million older adults who rely on SNAP benefits.

“These beneficiaries are some of the most vulnerable members of our society — and Republicans have put them at risk in order to pay for another tax cut mainly for the rich,” he says.

AARP: Safety Nets Shredded, Protections Undermined

Although AARP expressed strong opposition to many provisions in the reconciliation bill, the organization did support several key measures. These included increased investment in affordable housing through the Low-Income Housing Tax Credit, raising the additional senior standard deduction to $6,000, and expanding the Section 45S tax credit for paid family and medical leave.

Executive Vice President Nancy LeaMond criticized the bill’s cuts to Medicaid, ACA Marketplace coverage, and food assistance, calling them particularly harmful to older adults, rural residents, and family caregivers. She emphasized that over 17 million Americans aged 50 and older rely on Medicaid to remain in their homes and manage chronic health conditions.

“This is a moment to strengthen—not weaken—the supports that help people stay in their homes, access needed health care, and live with dignity and independence,” said LeaMond, representing nearly 38 million members nationwide.

She stressed that AARP remained strongly opposed to Senate provisions that would slash Medicaid, Marketplace coverage, and food assistance, making it harder for older adults to get by.

“More than 17 million Americans age 50 and older rely on Medicaid as a critical safety net to stay in their homes, manage chronic conditions, and afford long-term care,” says LeaMond. “By limiting how states fund their Medicaid programs, the new law threatens health care access—particularly for people in rural and underserved areas and through safety-net providers,” she adds.

LeaMond also expressed concern over delayed implementation of nursing home staffing standards, which are estimated to save 13,000 lives annually, and provisions allowing drug companies to continue charging high prices for certain orphan drugs—even while selling the same medicines overseas at far lower costs.

AARP opposes H.R. 1’s new burdens that could cost people their health care or food assistance when they are unable to work due to age discrimination, caregiving responsibilities, or chronic illness. “This will only make it harder for many older adults to access needed health care and to put food on the table,” she says.

She also warns that the new SNAP cost-sharing formula could shift billions in expenses to state budgets, forcing states to restrict eligibility, reduce benefits, or withdraw from the program entirely.

Finally, AARP strongly opposed the bill’s 10-year moratorium on state and local regulation of artificial intelligence (AI), arguing that it undermines consumer protections in employment, housing, and health care—leaving older adults more vulnerable to harm from biased or untested AI systems.

For additional information on H.R. 1’s impact on senior programs and service, visit: aarp.org/advocacy/fight-senate-cuts-medicaid-snap
aarp.org/advocacy/support-budget-bill-tax-proposals

HHS Shake-Up Sends Shockwaves Through Aging Network

Published on April 31, 2025

Taking a page from President Donald J. Trump’s to “Make America Great Again,” last week the U.S. Department of Health and Human Services (HHS) announced a major restructuring of the federal agency to “Make America Healthy Again.” The dramatic restructuring in accordance with Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.”

The U.S. Department of Health and Human Services (HHS), under management of HHS Secretary Robert F. Kennedy, Jr., last week announced a major restructuring and renaming of the federal agency under the initiative “Make America Healthy Again.” This dramatic reorganization follows Trump’s Executive Order, Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.

“We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” said HHS Secretary Robert F. Kennedy, Jr. in a statement announcing the massive overhaul. “This Department will do more—much more—at a lower cost to taxpayers.”

“Over time, bureaucracies like HHS become wasteful and inefficient, even when most of their staff are dedicated and competent civil servants,” Kennedy added. “This overhaul will be a win-win for taxpayers and those HHS serves. That’s the entire American public, because our goal is to Make America Healthy Again.”

During the Biden administration, HHS’s budget increased by 38%, and its staffing grew by 17%, prompting the new HHS chief to place the federal agency on the budgetary chopping block.

According to HHS, this restructuring will not impact critical services while saving taxpayers $1.8 billion per year through a reduction of approximately 10,000 full-time employees. When combined with other cost-cutting initiatives, including early retirement, and the Fork in the Road program, the total downsizing will reduce HHS’s workforce from 82,000 to 62,000 employees.

HHS also plans to streamline departmental functions. Currently, the agency’s 28 divisions contain redundant units. Under the restructuring plan announced on March 27, 2025, these units will be consolidated into 15 new divisions, including a newly created Administration for a Healthy America (AHA). Additionally, core organizational functions—such as Human Resources, Information Technology, Procurement, External Affairs, and Policy—will be centralized. The number of regional offices will be cut from 10 to five.

As part of the restructuring, several agencies will see workforce reductions. The U.S. Food and Drug Administration (FDA) will cut approximately 3,500 full-time employees, focusing on streamlining operations and centralizing administrative functions, though HHS asserts these reductions will not affect drug, medical device, or food reviewers, nor inspectors.

Similarly, the U.S. Centers for Disease Control and Prevention (CDC) will downsize by approximately 2,400 employees, refocusing its efforts on epidemic and outbreak response. The National Institutes of Health (NIH) will eliminate 1,200 positions by centralizing procurement, human resources, and communications across its 27 institutes and centers. Meanwhile, the Centers for Medicare and Medicaid Services (CMS) will cut around 300 positions, targeting minor duplication within the agency. HHS insists these changes will not impact Medicare or Medicaid services, but improve them.

Restructuring HHS to Focus on Chronic Illness Prevention

HHS’s overhaul aligns with the agency’s new priority of ending America’s chronic illness epidemic by focusing resources on ensuring safe, wholesome food, clean water, and the elimination of environmental toxins.

The Administration for a Healthy America (AHA) will consolidate five agencies—the Office of the Assistant Secretary for Health, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Agency for Toxic Substances and Disease Registry, and the National Institute for Occupational Safety and Health—into a single entity. This unification aims to enhance health resource coordination for low-income Americans, emphasizing primary care, maternal and child health, mental health, environmental health, HIV/AIDS, and workforce development.

Additionally, the Administration for Strategic Preparedness and Response, responsible for national disaster and public health emergency response, will be transferred to the CDC to strengthen its core mission of protecting Americans from health threats.

To combat waste, fraud, and abuse, HHS will create a new Assistant Secretary for Enforcement, overseeing the Departmental Appeals Board, the Office of Medicare Hearings and Appeals, and the Office for Civil Rights.

Furthermore, HHS will merge the Assistant Secretary for Planning and Evaluation with the Agency for Healthcare Research and Quality to form the Office of Strategy, enhancing research to inform policy decisions.
Critical programs under the Administration for Community Living (ACL), which supports older adults and people with disabilities, will be integrated into other HHS agencies, including the Administration for Children and Families, the Office of the Assistant Secretary for Planning and Evaluation, and the Centers for Medicare and Medicaid Services (CMS). HHS assures that these changes will not impact Medicare or Medicaid services.

Sounding the Alarm

Following the announcement of HHS’s restructuring plans, which would broad without a lot of detail, aging advocacy groups quickly released statements to voice strong concerns.

“For decades, the federal health programs that retirees and people with disabilities depend on have been ably administered under both Democratic and Republican administrations. However, the radical cutbacks proposed by the Trump administration place the delivery of these programs in jeopardy,” warned Dan Adcock, Director of Government Relations & Policy at the National Committee to Preserve Social Security and Medicare (NCPSSM).

Adcock also noted that HHS plans to eliminate the ALC and divide its responsibilities between two offices with no prior experience in this area. “This administration has already demonstrated a reckless disregard for public interests in favor of slashing operations and staff under the guise of ‘efficiency,’” he added. “So far, all they have done is create chaos and confusion, disrupting essential programs for seniors and the disabled. We view Secretary Kennedy’s plans with alarm.”

Nancy LeaMond, Executive Vice President and Chief Advocacy and Engagement Officer at AARP, also urged HHS to prioritize older Americans’ health needs. “HHS must ensure access to senior centers, community health centers, nutritious meals, Medicare assistance, and other vital services that countless older Americans rely on. Health is central to the lives, well-being, and financial security of AARP’s members and the more than 100 million Americans over age 50,” she emphasized.

Terry Fulmer, PhD, RN, FAAN, President of the John A. Hartford Foundation, echoed these concerns. “The announcement of workforce cuts at HHS comes at a time of unprecedented growth in America’s aging population. The proposed reorganization of ACL and its integration into other agencies requires careful consideration.”

Fulmer stressed that ACL administers programs essential to older adults’ daily lives, such as meal delivery, transportation to medical appointments, and chronic disease management. Absorbing these functions with far fewer staff demands careful planning. The government’s commitment to older adults requires a cautious approach, she said.

The Center for Medicare Advocacy also expressed deep concerns, particularly regarding plans to restructure ACL and consolidate oversight of Medicare appeals. “Given what we have seen with Social Security Administration cuts and restructuring, HHS’s claim that these changes won’t impact critical services rings hollow,” said Co-Director David Lipschutz.

LeadingAge, a national association representing nonprofit aging services providers, called for HHS to ensure older adults and their caregivers are not overlooked. “Cutting staff responsible for critical agency functions raises serious concerns. How will the work our members rely on get done? How will this impact quality care for older adults?” asked President and CEO Katie Smith Sloan.

Sloan also cautioned that reducing HHS’s field offices from 10 to five could impact CMS’s ability to oversee nursing home surveys and provider compliance. “A 25% workforce reduction must be undertaken with extreme care—especially given the millions of older adults who depend on these services,” she emphasized.

For a fact sheet on the HHS restructuring, visit https://www.hhs.gov/about/news/hhs-restructuring-doge-fact-sheet.html

Nursing home workforce crisis deepens with minimum staffing standards

Published in RINewsToday on February 13, 2023

“The long-term care industry is enduring the worst workforce crisis in its history, in Rhode Island, and across the country. Although providers are committed to recruiting and retaining staff to provide quality care for residents, despite our best efforts, many nursing homes have fallen short of the staffing ratio set by the RI Department of Health,” notes James Nyberg, Executive Director of the East Providence-based Leading Age Rhode Island (LARI), representing nonprofit providers of aging services.

“We are extremely  concerned about the impending fines that will be imposed on nursing homes here in Rhode Island as a result of our state’s existing nursing home minimum staffing ratio statute,” said Nyberg. Because of staffing ratio mandates, “the industry would have faced fines of over $11 million, in just one sample quarter (April – June 2022), since over 70% of nursing homes are not in compliance,” he said.  

“While April-June was a sample, the fines go into effect for July-September and we will receive a similar notice in just a few weeks, with only 10 days to pay the fine,” says Nyberg, stressing that these fines will only increase going forward if nursing homes are unable to meet the minimum staffing ratio.

Nyberg calls on the Rhode Island General Assembly to rescue Rhode Island’s nursing homes and provide relief from these penalties by delaying them and exploring an alternative approach to support the efforts of nursing homes to meet the ratio.  He warns that the current fine-based approach is excessive and counterproductive and will lead to reduced access to care and threaten the survival of the state’s nursing homes.

Nyberg points out that the current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (five nursing homes have already closed since the COVID pandemic began).  These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes.  

“We are working with numerous stakeholders on various initiatives to develop a pipeline of workers, but the simple fact is that it will take time.  In addition, as you know, the industry has faced years of underfunding from Medicaid, which pays for the majority of nursing home care.  This has made recruiting and retaining workers more difficult than ever,” says Nyberg. 

John Gage, President of the Rhode Island Health Care Association (RIHCA) agrees with Nyberg’s assessment of the nursing home workforce.  “Nursing homes across the nation are facing an historic labor shortage as the direct result of chronic Medicaid underfunding and the devastating impact of the Covid-19 pandemic on the workforce, he says, noting that the state’s nursing home workforce is down 20% since the start of the pandemic, with 2,000 workers lost from Jan. 2020 to June 2022.  Nationwide, the nursing home workforce is down 210,000 workers.

According to Gage, Rhode Island’s staffing mandate, while well-intentioned, will siphon tens of millions of dollars from resident care. In the first year of full implementation of the state’s minimum staffing mandate, RIHCA estimates that facilities will be fined upwards of $60 million. “These fines will imperil care, not bolster it,” he warns.  

Without legislative action, Rhode Island nursing homes will be fined an estimated $11 million on or about February 28, 2023, because of their inability to attract workers to meet the mandate from July 1, 2022, through September 30, 2022, Gage charges. “There are simply not enough available workers to fill the open staff positions, and resources are scarce.  Nursing homes will be devastated by these fines.  Facilities will reduce admissions, backing up hospital referrals and clogging hospital beds.  More nursing facilities will close – five have already closed since the beginning of the pandemic,” he predicts.  

Gage asks, “Who will care for Rhode Island’s frailest elders?” To recreate a minimum staffing mandate in nursing homes on the federal level would be a huge mistake, especially given the historic workforce crisis here in Rhode Island and nationwide,” he says.  

Gage’s comments echo concerns expressed by another group of US Senators in Jan. 20 correspondence (https://www.tester.senate.gov/wp-content/uploads/1-20-23-Nursing-Home-Staffing-Mandate-Letter-FINAL.pdf) sent to CMS by Senators John Bourasso, Jon Tester, and eleven other US Senators.  They caution the agency that a one-size fits all mandate would undermine access to care for patients, and they encouraged CMS to work with Congress on tailored solutions that address the workforce challenges facing nursing facilities.

At the federal level

Just days ago, U.S. Senators Bob Casey (D-PA), Chairman of the Senate Committee on Aging, and Ron Wyden (D-OR), Chairman of the Senate Finance Committee, called on the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure to encourage the federal agency to establish minimum staffing standards in nursing homes to ensure high-quality care for nursing home residents. In Feb. 10 correspondence, Casey and Wyden, along with Senators Sherrod Brown (D-OH), Kirsten Gillibrand (D-NY), Richard Blumenthal (D-CT), Cory Booker (D-NJ), and Elizabeth Warren (D-MA) urged CMS to advance the agency’s ongoing study to determine adequate staffing requirements in nursing homes.

“We appreciate the work that CMS has undertaken to promote safety and quality in nursing homes and applaud the Biden-Harris Administration’s commitment to protecting our nation’s seniors,” said the senators in Feb. 10 correspondence, urging CMS to “bring this work to completion.” 

“In our view, that means continuing the agency’s ongoing study to determine the level of staffing that is necessary to ensure safe and high-quality care for nursing home residents, developing an evidence-based and actionable proposal for mandatory minimum staffing levels, and a robust and transparent process—including direct stakeholder engagement— that will allow for further discussion and fine-tuning of requirements before the proposal is finalized,” wrote the senators.

The senators noted that studies have shown a correlation between inadequate staffing levels and lower quality of care. More recent studies have demonstrated that higher nurse staffing ratios mitigated the effect of COVID-19 outbreaks in nursing homes and resulted in fewer deaths. A recent Department of Health and Human Services Office of Inspector General report examining the high level of COVID-19 infections in nursing homes also pointed to the need for the establishment of minimum staffing requirements.  

In the correspondence, the senators cite the Social Security Act, which requires skilled nursing facilities to “provide 24-hour licensed nursing service which is sufficient to meet nursing needs of its residents,” including the services of a registered nurse at least 8 consecutive hours per day, 7 days a week. The letter commends CMS for working to update this vague standard that has led to substantial variation in staffing levels and quality of patient care across facilities.

“Achieving the shared goal of ensuring quality care in nursing homes nationwide is a complex undertaking, says LeadingAge’s Ruth Katz, senior vice president, policy. LeadingAge is an association of nonprofit providers of aging services, including nursing homes.

“As our Get Real on Ratios proposal highlights, a number of conditions must be met in advance of any mandate implementation,” suggests Katz. “The senators correspondence to CMS is a promising development; it covers many of the same points as our Get Real on Ratios proposal – a recognition of the critical need for adequate reimbursement; that one size does not fit all, and that workforce shortages will need to be addressed with additional support. Without addressing these, staffing mandates are impossible. We look forward to continuing our discussions with Congressional leaders on this critical issue so that older adults and families can access much-needed care and services,” she says.

“The Senior Agenda Coalition of RI fully supports the need to develop national staffing standards to ensure quality care is provided to nursing home residents across our nation. It is important to note that Rhode Island has been a leader in this area. For many years our state has required 24/7 RN coverage in nursing homes and in 2021 the legislature passed the Nursing Home Staffing and Quality Care Act that includes staffing standards,” says Maureen Maigret, Policy Advisor to Senior Agenda Coalition of RI. “Now we must work to address workforce shortage issues and ensure that adequate government resources are provided especially through Medicaid payments so the standards can be met, and our critical direct care workers receive competitive living wages in order to keep them working in long term care,” she adds.

As the House Leadership hammers out the FY 2024 budget, it is crucial that adequate Medicaid funding is allocated to allow nursing homes to attract the necessary staff to meet the state’s minimum nursing standards that it codified into law. We must address this policy problem now rather than just kick the can down the road.