Some Trump health care rollbacks affecting older people
The Trump administration’s “enthusiasm for deregulation” is impacting care for older people, says KFF in an article that’s part of its “New Old Age” partnership with The New York Times.
Long-term care staffing
After decades of advocacy, the Biden administration in 2023 tackled the problem of perennial understaffing of long-term care facilities. Officials backed a Medicare regulation to mandate at least 3.48 hours of care from nurses and aides per resident per day and would require a registered nurse on-site 24 hours a day, seven days a week.
But industry lawsuits blocked most of the rule, with two federal district courts finding that Medicare had exceeded its regulatory authority.
Then, in July, as part of Republicans’ One Big Beautiful Bill Act, Congress prohibited Medicare from implementing the staffing standards before 2034. And last month, the Centers for Medicare & Medicaid Services repealed the standards altogether.
Home help
The Labor Department has returned to a policy excluding home care workers from the federal Fair Labor Standards Act.
In 2013, after decades of advocacy, a Labor Department rule brought home care workers under the labor act, entitling them to the minimum wage, time and a half for overtime work, and payment for travel time between clients.
In July, the Labor Department announced that it would return to 1975 regulations and stop enforcing the 2013 rule.
Prior authorizations
The Trump administration has introduced a Medicare experiment for prior authorizations, now getting underway in six states, that has alarmed advocates, congressional Democrats, and older Americans, says KFF.
The program, called WISeR — Wasteful and Inappropriate Service Reduction — begins in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington in a six-year trial to determine whether review by tech companies can reduce costs and improve efficiency, while maintaining or improving quality of care.
WISeR initially will target 17 items and services that CMS says “historically have had a higher risk of waste, fraud and abuse.” The list includes knee arthroscopy for arthritis, electrical nerve stimulation devices for several conditions and impotence treatment.
Algorithmic denials will trigger review by “an appropriately licensed human clinician” and the tech companies will get “a share of averted expenditures.”
“It injects some of the worst of Medicare Advantage into traditional Medicare,” says David Lipschutz, co-director of the Center for Medicare Advocacy. The six vendors that approve or reject treatments “have a financial stake in the outcomes,” he says, and therefore “an incentive to deny care.”
Democrats have introduced bills in both the House and Senate to repeal WISeR.
The Capitol switchboard, to be connected to the offices of senators and representatives, is (202) 224-3121.
The KFF/Times “New Old Age” partnership began in April; you can access all the articles here.
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