Tag Archives for Medicare

Using Savings from Drug Pricing Reform to Expand Medicare

Published in RINewsToday on June 7, 2021

Ahead of President Biden’s first address to a joint session of Congress on April 28 and as the Democratic administration considers policies to slash rising drug costs, the U.S. Government Accountability Office (GAO) released a 65-page report finding that the U.S. pays more than two to four times higher prices for a selected sample of 20 single source, brand name drugs than Australia, Canada and France. The latest GAO report, commissioned by Sen. Bernie Sanders (I-Vt.), found that Americans, suffering from blood clots, bronchitis, emphysema and Hepatitis C, were paying more for life-saving treatments than patients in these industrialized countries. 

“This important GAO study confirms what we all already know: the pharmaceutical industry is ripping off the American people,” said Sen. Sanders in a statement announcing the March 29th release of the GAO report, “Prescription Drugs: US Prices for Selected Brand Drugs Were Higher on Average Than Prices in Australia, Canada and France.”

“The time is long overdue for the United States to do what every major country on earth does: negotiate with the pharmaceutical companies to lower the outrageous price of prescription drugs. I would urge the president to put this proposal in the American Families Plan and use the savings to expand and improve Medicare for older Americans. We can no longer tolerate the American people paying, by far, the highest prices in the world for prescription drugs,” says the Vermont Senator who chairs the Senate’s Budget Committee.

U.S. Paying Outrageous Drug Prices

The GAO study found that in 2020, the U.S. paid 4.36 times more than France, 4.25 times more than Australia and 2.82 times more than Canada for the selected drugs, which represent a sample of the drugs with the highest Medicare Part D expenditures and use. The researchers noted that the publicly available data for the comparison countries were gross prices that did not reflect potential discounts. As a result, the actual differences between U.S. prices and those of the other countries were likely much larger than GAO estimates.

According to the GAO report, while France and Australia operate universal, publicly funded health systems that include prescription drug coverage, both Canada and the U.S. have a significant number of people who do not have prescription drug coverage. But even when comparing the full cash retail prices of selected drugs, the prices quoted to individuals without prescription drug coverage, GAO found that prices were two to eight times higher in the U.S. than the same drugs from pharmacies in Canada. 

For instance, GAO found that the cash price of Epclusa (28 tablets), which treats Hepatitis C, or an infection that attacks the liver, is $36,743 in the U.S. but $17,023.63 in Canada. The cash price of Harvoni (28 tablets), which also treats Hepatitis C, is $46,570.33 in the U.S. but $19,084.54 in Canada. In another example, GAO cited that the cash price of Incruse Ellipta Inhalation Powder (30 inhalations), which treats chronic obstructive pulmonary disease (COPD), or a group of lung diseases which block airflow and make it difficult to breath, is $411.33 in the U.S. but $53.31 in Canada.

Because France and Australia have universal health systems that cover prescription drugs, Australians would pay up to a $28.09 copay for a month supply of these medicines, while patients in France would pay anywhere from $0 to $34.03 for the drugs. The maximum copay that high income seniors with prescription drug coverage in Ontario, Canada would pay for the drugs is $4.67.

Robbing Peter to Pay Paul

On April 23, 48, organizations, led by Indivisible, Social Security Works and Public Citizen, called on Biden to include bold drug pricing reforms in American Families Plan to expand Medicare, and the result of a new polls supports this legislative action. 

Drug pricing reform will produce upward of $450 billion in savings over 10 years, note the organizations, urging Biden to use these savings to reinvest in Medicare. The call for adding dental, vision and hearing benefits to Medicare, lowering the Medicare eligibility age to 50 and creating an out-of-pocket cap for medical expenses.

Alongside the letter, the organizations released the findings of a new poll from Data for Progress, widespread public support across party lines for expanding and improving Medicare. The poll’s findings noted that 86% of Americans, including 82% of Republicans, support adding dental, hearing and vision benefits to Medicare. It also found that three-quarters of Democrats, a majority of independents, and nearly half of Republicans support lowering the Medicare eligibility age to 55. 

“Allowing Medicare to negotiate drug prices down saves money for the federal government, which is the largest buyer of prescription drugs in the world,” said Alex Lawson, Executive Director of Social Security Works. “We must pump those savings back into Medicare to expand eligibility and add benefits that equalize Medicare with private insurance,” he says.

“Lowering the Medicare eligibility age to 50, capping out-of-pocket costs, and expanding benefits to include dental, hearing, and vision would improve access to care for millions of Americans. Far too many Americans have lost their insurance or put off needed care due to the COVID-19 crisis,” said Eagan Kemp, Health Care Policy Advocate for Public Citizen. “The Biden Administration and Congress have a chance to deliver important progress at a crucial time,” he says.

Adds Mary Small, Legislative Director for Indivisible, “With the consequences of the COVID-19 pandemic still being felt in our communities, now is a crucial moment to expand public health care coverage and deliver savings on prescription drug prices to the American people. Lowering the Medicare eligibility age to 50 will be an essential step toward reducing the racial health inequities by increasing coverage to communities of color and low-income folks.”  She adds, “Allowing Medicare to negotiate prescription drug prices and then reinvesting those savings back into the program to expand services further strengthens our path toward universal coverage for all.” 

Last Thoughts

Garnering applause, Biden put high drug costs on his Administration’s radar screen at his recent address before Congress. “Let’s give Medicare the power to save hundreds of billions of dollars by negotiating lower drug prescription prices. It won’t just help people on Medicare. It will lower prescription drug costs for everyone,” said the 46th President of the United States. “We’ve talked about it long enough. Democrats and Republicans, let’s get it done this year,” he said.

But actions speak louder than words, say Washington Insiders.  They note that Biden’s American Families Plan, did not include any proposal to slash pharmaceutical costs or lower the Medicare eligibility age. Is it possible for Biden to lower the drug prices in the United States, making the prices more comparable to other industrialized countries and to even expand Medicare, in the face of fierce opposition from Republicans, moderate Senate Democrats and pharmaceutical companies?  

According to the latest KFF Health Tracking Poll released June 3, 2021, the findings indicate that “nearly nine in 10 (88%) favor allowing the federal government to negotiate for lower prices on medications, including three-fourths (77%) of Republicans, nine in 10 independents (89%) and 96% of Democrats.” However, support dwindles “when the public hears argument made by pharmaceutical companies that it could lead to less research and development for new drugs, or that access to newer prescriptions could be limited,” say the researchers.

Will political pressure sway a divided Congress before the upcoming midterm elections to hammer out a bipartisan solution to put the brakes to the nation’s skyrocketing drug costs and to provide more American’s affordable health care through an expanded Medicare program. Its wait and see.

Cicilline Moves to Re-Establish the House Permanent Select Committee on Aging

Published in RINewsToday on April 30, 2021

Congressman David Cicilline is poised to offer a resolution to re-establish the House Permanent Select Committee on Aging, whose work came to an end in early January 1993, at the conclusion of the 102nd Congress.

The Washington, DC-based Leadership Council of Aging Organizations (LCAO), a coalition of 69 aging organization, has recently called on the House to support Cicilline’s measure when introduced, “which focuses on the well-being of America’s older population and is committed to representing their interests in the policy-making arena”.

“Now is the opportune time to reestablish the House Aging Committee,” says LCAO Chair, Max Richtman, who serves as President and CEO of the National Committee to Protect Social Security and Medicare (NCPSSM), in an endorsement letter sent to the Rhode Island Congressman on March 30, 2021, detailing the graying of America. 

“Every day, 12,000 Americans turn 60. By 2030, nearly 75 million people in the U.S.—or 20 percent of the country—will be age 65 or older. As America grows older, the need for support and services provided under programs like Social Security, SSI, Medicare, Medicaid and the Older Americans Act also increases,” he said, stressing the importance of this select committee.

The resolution to approve the House Aging Committee was passed on October 8, 1974, by a 299–44 margin in the House. Its legislative duties expired during the 103rd Congress, as the House leadership was under pressure to reduce its internal costs and to streamline the legislative process. Initially, the House panel had 35 members, but would later grow to 65 members.

Those opposing reauthorizing the House Aging Committee would say that its elimination would slash wasteful spending, after all, the chamber already had 12 standing committees with jurisdiction over aging issues. On the other hand, advocates warned that the staff of these committees did not have time to broadly examine aging issues as the select committee did.

In a March 31, 1993 article published in the St. Petersburg Times, reporter Rebecca H. Patterson reported that Staff Director Brian Lutz, of the Committee’s Subcommittee on Retirement Income and Employment, stated that “during its 18 years of existence the House Aging Committee had been responsible for about 1,000 hearings and reports.”

The Fourth Time “Hopefully” is the Charm…

Over 28 years after the House Democratic Leadership’s belt-tightening efforts to save $1.5 million resulted in the termination of the House Aging Committee, Rhode Island Congressman David Cicilline is poised to reintroduce legislation to reestablish the House Aging panel, active from 1974 until 1993.

More than five years ago, Cicilline had introduced H. Res. 758 during the 114th Congress to reestablish the House Aging Committee. Rhode Island Congressman Langevin and 27 Democratic lawmakers out of 435 House members became cosponsors. But it caught the eye of the co-chairs of the Seniors Task Force (later renamed the House Democratic Caucus Task Force on Aging & Families), Congresswomen Doris Matsui (D-CA) and Jan Schakowsky (D-IL). The lawmakers also signed onto supporting this resolution.

Correspondence penned by Cicilline urged House Speaker Paul Ryan (R-WI) and House GOP leadership to support House Res. 758. Ultimately, Ryan blocked the resolution from being considered and no legislative action was taken in the GOP-controlled House chamber. 

With House Speaker Ryan still retaining the control of the House during the 115th Congress, Cicilline’s H. Res.160 would not gain traction. At that time only 27 Democratic lawmakers stepped forward to become cosponsors, the resolution attracting no support from House GOP lawmakers.  

For the third time, during the 116th Congress, Cicilline would again introduce H. Res. 821 to reestablish the House Aging Committee. Even with the Democrats retaking the House and House Speaker Nancy Pelosi taking control of the chamber’s legislative agenda, the resolution would not get a committee vote, again blocking it from reaching the floor for a vote.

During the 117th Congress, Cicilline is not taking “no” for an answer, and continues his push to bring back the House Aging Committee.  Once his resolution is thrown into the legislative hopper, it will be referred to the House Committee on Rules for mark-up and if passed will be considered by the full House. It’s expected to be just 245 words like the previous ones introduced during the last three Congresses.  

The Resolution: Short and Sweet

Cicilline’s resolution would reestablish a House Aging Committee without having legislative jurisdiction, this being no different than when the select committee previously existed. It would be authorized to conduct a continuing comprehensive study and review of aging issues, such as income maintenance, poverty, housing, health (including medical research), welfare, employment, education, recreation, and long-term care. These efforts impacted legislation taken up by standing committees.

According to the Congressional Research Service, it is relatively simple to create an ad hoc (temporary) select committee by approving a simple resolution that contains language establishing the committee—giving a purpose, defining membership, and detailing other issues that need to be address.  Salaries and expenses of standing committees, special and select, are authorized through the Legislative Branch Appropriations bill.

This resolution would also authorize the House Aging Committee to study the use of all practicable means and methods of encouraging the development of public and private programs and policies which will assist seniors in taking a full part in national life and which will encourage the utilization of the knowledge, skills, special aptitudes, and abilities of seniors to contribute to a better quality of life for all Americans.

It would also allow the House Aging Committee to develop policies that would encourage the coordination of both governmental and private programs designed to deal with problems of aging and to review any recommendations made by the President or by the White House Conference on Aging in relation to programs or policies affecting seniors.

“After a lifetime of working hard and playing by the rules, Rhode Island seniors should be able to enjoy their retirement years with dignity and peace of mind. Re-establishing the House Aging Committee will help make this goal a reality. From protecting Social Security and Medicare to lower the costs of housing and prescription drugs, this Committee will help ensure we can deliver better results for seniors here in Rhode Island and across America,” says Cicilline.

Looking Back

According to NCPSSM’s Richtman, who served as staff director for the Senate Special Committee on Aging from 1987 to 1989, the House Aging Committee historically served as a select committee that fostered bipartisan debate from various political and philosophical viewpoints to promote political consensus that, in turn, impacted the legislation that was taken up in authorizing committees. This select committee would have an opportunity to more fully explore a range of aging issues and innovations that cross Committee jurisdiction, while holding field hearings, convening remote hearings, engaging communities and promoting understanding and dialogue.

While seeing the value of the House Aging Committee, Richtman speculates that regardless of which party is in the majority, the challenge of re-establishing the select committee is that the Legislative Branch appropriation would require that existing House standing committees forgo some funding and staff to create a budget and staff for the Aging Committee. Given that the Aging Committee could have no legislative jurisdiction; the authorizing committees would not lose legislative power.

Robert Blancato, president of Matz, Blancato, and Associates, who was the longest-serving staff person on the original House Aging Committee, from 1977 to 1993, sees the need to bring back the House Aging Committee. “It provided a deeper examination of issues affecting older adults through hearings, investigations, and reports. Every member of the committee was also a member of a standing committee and could take their expertise to into that work,” he noted.

Blancato, who served with three chairs — Will Randall (D-MO), Claude Pepper (D-FL) and Edward Roybal (D-CA), warns that a “floodgate problem” may well derail Cicilline’s efforts to get his resolution passed. “You create one and there will be pressure to create more,” says Blancato. But, bringing back the House Aging Committee is extremely important because there is no “stated expertise in any current standing committee [to investigate] on aging issues,” he adds.

America’s aging population warrants reestablishing the House Aging Committee, says Professor Fernando Torres-Gil, M.S.W., Ph.D., Social Welfare and Public Policy Director, Center for Policy Research on Aging at the UCLA Luskin School of Public Affairs. “By 2029, all 80-plus individuals born between l946 and l964 will be 65 years of age and over. These so-called “aging baby boomers” will create challenges and opportunities that the Congress must examine, understand and respond to with legislation, oversight and partnerships with government, stakeholders and advocates,” says Torres Gill, who served as the select committee’s staff director from 1985 to 1987.

Under the Chairmanship of Congressmen Roybal and the partnership with the ranking minority member, Congressman Rinaldi (R-TX), Torres-Gil saw first-hand the tremendous influence that this select committee had on influencing and motivating House members to promote thoughtful responses to the needs of older Americans, “It served as one of the few venues for bi-partisanship and long-term planning on complex issues facing older persons,” he stated.

According to Torres-Gil, the complexities of an aging society will increase given the pandemic, the growing voices of immigrants, ethnic and minority groups and the challenges for ensuring the financial viability of legacy entitlement programs: Social Security, Medicare, Medicaid, the Older Americans Act.  “Now is the time to bring back this vital congressional “thought leader” on legislative action for the aging and diversity of the United States,” he says.

To illustrate the importance of the House Aging Committee, Bill Benson, Staff Director of the Committee’s Subcommittee on Housing and Consumer Interests from 1987 to 1990, (chaired by Congressmen Don Bonker (D-WA) and later James Florio (D-NJ), points to his subcommittee’s work on housing issues. “Both before, during, and after my tenure with the subcommittee, we were able to dig deeply into a multitude of significant housing-related programs and problems facing older Americans. During my tenure alone we conducted at least a dozen hearings just on housing, addressing affordability, quality and appropriateness, contributing significantly to legislative action,” he said.

“I am certain that in just that over two-year period we held far more hearings on housing and aging than have been conducted, in total, in the nearly three decades since. During this interum, there has been almost no congressional attention to housing for the elderly. It is no surprise that today we see homelessness among older adults increasing rapidly, among many other housing problems facing older Americans,” adds Benson, stressing that resurrecting the House Aging Committee is crucial to housing policy for the elderly, along with so many other crucial issues.

The Amazing Legacy of Fiery Senior Advocate Claude Pepper

Kathleen Gardner served as Claude Pepper’s staff director of the Subcommittee on Health and Long-Term Care, from 1984 until his death in 1989, and continued to serve Pepper’s successor, Edward Roybal, until the House Aging Committee was abolished.  She was the last surviving member of the Subcommittee, boxing up and archiving its papers for delivery to the Tallahassee, Florida-based Claude Pepper Foundation.   

According to Gardner, few know that it was Pepper who was largely responsible for sponsoring or cosponsoring legislation to establish the majority of the Institutes of Health (including the National Heart and Cancer Institutes, the Deafness and Arthritis Institutes, the National Institute of Mental Health and six other Institutes). “One of his last legislative improvements to the National Institutes of Health was the establishment of the National Center for Biotechnology Information at the National Library of Medicine – without which the mapping of the human genome – which will unlock so many of the mysteries of disease — would not have been possible, she adds. 

Between 1982 to 1990, Melanie Modlin served as a Professional Staff Member for the full Committee and ultimately became Gardner’s Deputy Director for the Subcommittee on Health and Long-Term Care.  She remembered how the House Aging Committee investigated “Diploma mills,” by setting up its own diploma mill, then a phony accreditation to give the investigators credence.  The select committee also held one of the first hearings on Alzheimer’s disease, which was just beginning to become a household word. 

Modlin recalled that her Subcommittee was tasked with creating a universal health care bill. “Once more, Pepper and the House Aging Committee was a step ahead of the curve,” she says, noting that this debate has come back to Congress.

As newspapers in communities across the nation curtail or jettison their investigative teams, the House Aging Committee has a proven track record and reputation of investigating aging issues is a sound reason as to why the Select committee should be reactivated, says Modlin, especially with the rapid growth of America’s aging population.  

Robert S. Weiner, President, Robert Weiner Associates News, who was a close friend and confidant of Pepper, clearly knew the importance and impact of Pepper’s House Aging Committee on the daily quality of life of seniors. Weiner, who served as Staff Director for the Subcommittee on Health and Long-term care from 1975 to 1977 and Chief of Staff of the full Aging Committee, from 1976 to 1980, remembered, “I was thunderbolt struck when [GOP House Speaker] Newt Gingrich abolished the Aging Committee – the Senate wisely kept theirs.”

“Congressman Claude Pepper used the House Aging Committee as a force for the elderly. Bringing it back would be of immeasurable help regardless of which party has the White House in assuring the best health care programs possible, stopping any raiding of the Social Security Trust Fund, and protecting seniors,” says Weiner.

The House Aging Committee prodded Congress to act in abolishing forced retirement, investigating nursing home abuses, monitoring breast screening for older women, improving elderly housing, and bringing attention to elder abuse by publishing a number of reports, including “Elder Abuse: An Examination of a Hidden Problem and Elder Abuse: A National Disgrace,” and “Elder Abuse: A Decade of Shame and Inaction.” The Committee’s work would also lead to increased home care benefits for the aging and establishing research and care centers for Alzheimer’s Disease.

“One of the best known aging accomplishments of Claude Pepper was to end mandatory retirement by amending the Age Discrimination provision in the Employment Act, remembered Weiner, noting that this would get him the cover of Time Magazine with the tag line the “Spokesman for the Elderly.” 

Kentucky Fried Chicken King makes his mark

It was Pepper’s idea to bring in Col. Harland Sanders as a witness. Many still remember the 81-year-old Kentucky Fried Chicken King, wearing his trademark spotless white suit and black string tie, and testifying against mandatory retirement in federal jobs,” said Weiner, noting that a few years later it would end up also in the private sector, and the bill would pass 359 to 2 in the House and 89 to 10 in the Senate, with President Carter signing the bill despite strong opposition of the Business Roundtable and big labor, he said.

Weiner also noted that among the House Aging Committee’s other accomplishments under Pepper’s Chairmanship was legislation creating standards for supplemental insurance and holding hearings to expose cancer insurance duplication. “Witnesses were literally forced to wear paper bags over their heads to avoid harassment by the insurance companies. That legislation became law,” he said.

As a long-time Washington insider, Weiner sees the best avenue of bringing the House Aging Committee back from the dead is to get House Speaker Nancy Pelosi (D-CA) and her leadership team, Congressmen Steny Hoyer (D-MD and James E. Clyburn (D-SC), to support Cicilline’s resolution.  “It’s not just a matter of ‘getting them to say ok – it’s using the right way to do it that works. While you can get groups to support your efforts to bring back the House Aging Committee, you must verbally make the case to House leadership,” says Weiner.  Looking back, “that’s how Pepper always did it – he’d pull people to a place on the floor and talk with them.”

“If he gets those three, or even one or two, and they tell the other two – done deal – it goes to the floor of the caucus for a vote,” notes Weiner.

In Summary…

Over thirty years after the death of Claude Pepper (D-FL) in 1989, no national advocate has emerged to take the place of the former Chairman of the House Aging Committee, who served as its chair for six years. As a result, House Democratic lawmakers and aging advocates are forced every new session of Congress to fend off proposals to cut aging programs, Social Security, and Medicare. 

Gardner believes that Cicilline’s efforts to reestablish this needed Select Committee would be a salute to Pepper, the nation’s most visible spokesperson for seniors, and more importantly to his desire to establish a “legislative voice” for our nation’s most vulnerable population – our senior citizens.”   

Hopefully House Speaker Nancy Pelosi will agree with Gardner’s assessment.  If only for the sake of the nation’s seniors.

For details about the Claude Pepper Foundation, go to https://claudepepperfoundation.org/about/claude-pepper-center/. 

Time to resolve RI’s ongoing Nursing Home staffing crisis

Published in RINewsToday on April 18, 2021

The latest release of AARP’s Nursing Home COVID-19 Dashboard shows that both cases and deaths in nursing homes declined in the four weeks ending March 21. Although these rates are improving, chronic staffing problems in nursing homes—revealed during the COVID-19 pandemic—continue. In Rhode Island, 30% of nursing homes reported a shortage of nurses or aides, which is only fractionally better than the previous reporting period. 

AARP has come out swinging to fight for enhancing the quality of care in Rhode Island’s 104 nursing homes.

AARP Rhode Island, representing 131 members, calls for the General Assembly to ensure the quality of care for the state’s nursing home through minimum staffing standards, oversight, and access to in-person formal advocates, called long-term care Ombudsmen. The state’s the largest aging advocacy group has urged lawmakers to create a state task force on nursing home quality and safety and has pushed for rejecting immunity and holding facilities accountable when they fail to provide adequate care to residents.  It’s also crucial that Rhode Island ensures that increases in nursing homes’ reimbursement rates are spent on staff pay and to improve protections for residents, says AARP Rhode Island. 

Last December, AARP Rhode Island called on Governor Gina Raimondo to scrap Executive Order 20-21 and its subsequent reauthorizations to grant civil immunity related to COVID-19 for nursing homes and other long-term care facilities. The aging advocacy group warned that these facilities should be held responsible for providing the level of quality care that is required of them for which they are being compensated.

Rhode Island Lawmakers Attack Nursing Home Staffing Crisis

During the legislative session, the state’s nursing home staffing crisis caught the eye of Senate Majority Whip Maryellen Goodwin is a policy issue that needs to be addressed. They knew that Rhode Island ranked 41st in the nation in the number of the average hours of care nursing home residents receive, according to data from the Centers for Medicare and Medicaid Services.  The state also has the lowest average resident-care hours per day of any New England state.

On Feb. 2, the Rode Island Senate approved S 0002, “Nursing Home Staffing and Quality Care Act” sponsored by Goodwin and nine Democratic cosponsors to address an ongoing crisis in staffing nursing homes that has been exacerbated by the COVID-19 pandemic.  The bill had passed unanimously in the Health and Human Services Committee, and ultimately, the full Senate gave its thumbs up to the legislative proposal by a vote of 34 to 4.  Only one Republican senator crossed the aisle and voted with the Democratic senators.

“There is a resident care crisis in our state. Staffing shortages and low wages lead to seniors and people with disabilities not receiving the care they desperately need. The pandemic, of course, has exponentially increased the demands of the job and exacerbated patients’ needs. We must confront this problem head-on before our nursing home system collapses,” said Sponsor Senator Goodwin (D-Dist. 1, Providence).

The legislation would establish a minimum standard of 4.1 hours of resident care per day, the federal recommendation for quality care long endorsed by health care experts including the American Nurses Association, the Coalition of Geriatric Nursing Organizations, and the National Consumer Voice for Quality Long-Term Care. The bill, which the Senate also approved last year, has been backed by Raise the Bar on Resident Care, a coalition of advocates for patient care, and the Rhode Island’s Department of Health (RIDOH).

The bill would also secure funding to raise wages for caregivers to recruit and retain a stable and qualified workforce. Short staffing drives high turnover in nursing homes. Not only does high turnover create undue stress and burnout for remaining staff, but it also diverts valuable resources to recruit, orient, and train new employees and increases reliance on overtime and agency staff.  Low wages are a significant driver of the staffing crisis. The median wage for a CNA in Rhode Island is less than $15, and $1/hour lower than the median wage in both Massachusetts and Connecticut.

The legislation would also invest in needed training and skills enhancement for caregivers to provide care for patients with increasing acuity and complex health care needs.

At press time, the companion bill (2021-H-5012), sponsored by Reps. Scott A. Slater (D-Dist.10, Providence) and William W. O’Brien (D-Dist. 54) was considered by House Finance Committee and recommended for further study.

RIDOH’s Director Nicole Alexander-Scott, MD, MPH says the state agency “supports the thoughtfulness of the provisions included in the legislation and welcomes dialogue with its sponsors, advocates, and the nursing home facility industry regarding methods to sustain the necessary conditions associated with the intent of the bill.”

Alexander-Scott states that “RIDOH takes its charge seriously to keep nursing home residents and is supportive of efforts to update standards of care to better serve Rhode Islanders in nursing facilities, as well as increase resident and staff satisfaction within nursing facilities.”

Scott Fraser, President and CEO of the Rhode Island Health Care Association (RIHCA), a nonprofit group representing 80 percent of Rhode Island’s nursing homes, says that “staffing shortages are directly traceable to the chronic lack of Medicaid funding from past governors. Period.” 

According to Fraser, state law requires Medicaid to be funded at a national inflation index, usually averaging around 3%. “Up until this year, previous governors have slashed this amount resulting in millions of dollars in losses to our homes.  Thankfully, Governor McKee is proposing to fully fund the Medicaid Inflation Index this year,” he says.

RIHCA opposes the mandatory minimum staffing the legislation now being considered by the Rhode Island General Assembly, says Fraser, warning that its passage would result in facilities closing throughout the state. “No other state has adopted such a high standard,” he says, noting that the Washington, DC-based American Health Care Association estimates that this legislation would cost Rhode Island facilities at least $75 million to meet this standard and the need to hire more than 800 employees. 

Fraser calls for the “Nursing Home Staffing and Quality Care Act” to be defeated, noting that the legislation does not contain any provisions for funding.  “Medically, there is no proof that mandating a certain number of hours of direct care results in any better health outcomes.  This is an unfunded legislative mandate. If homes are forced to close, not only would residents be forced to find a new place for their care, but hundreds of workers would also be forced out of work,” he says.

Goodwin does not believe that mandating minimum staffing requirements in nursing homes will force nursing homes to close. She noted that the legislation is aimed at ensuring nursing home residents receive adequate care and that Rhode Island is the only state in the northeast without such a standard.

“There is an un-level playing field in nursing home staffing in Rhode Island,” charges Goodwin, noting that many facilities staff 4.1 hours per day, or close to it, while others only provide two hours of care per day. “In either case, the overwhelming majority of well-staffed and poorly-staffed nursing homes remain highly profitable,” she says. 

According to Goodwin, the lack of staffing and certified nursing assistants (CNAs) is due to unreasonable workloads and low pay. “RIDOH’s CAN registry makes it clear that retention of these workers is a big issue. This is in part because they can make as much money – or more – in a minimum wage profession with much less stress,” she adds, stressing that “The Nursing Home Staffing and Quality Care Act” directly addresses these staffing challenges.

One quick policy fix is to provide nursing home operators with adequate Medicaid reimbursement to pay for increased staffing.  Lawmakers must keep McKee’s proposed increase of nursing home rates pursuant to statute, requiring a market-based increase on Oct. 2021, in the state’s FY 2020 budget. The cost is estimated to be $9.6 million.

With the House panel recommending that Slater’s companion measure ((2021-H-5012) to be held for further study, Goodwin’s chances of seeing her legislation becoming law dwindles as the Rhode Island Assembly’s summer adjournment begins to loom ever closer. There’s probably no reason to insist that a bill be passed in order to have a study commission, so this could be appointed right away if there is serious intent to solve this problem.

Slater’s legislation may well be resurrected in the final days of the Rhode Island General Assembly, behind the closed doors when “horse-trading” takes place between House and Senate leadership.  If this doesn’t occur, either the House or Senate might consider creating a Task Force, bringing together nursing home operators, health care professionals and staff officials, to resolve the state’s nursing home staffing crisis.