Experts Say Trump Presidency, Senate Republican Control Could Help Homecare

WASHINGTON—A Donald Trump presidency—and more critically, the possibility of a Republican-controlled White House and Congress—could bring benefits to the homecare industry, insiders said the day after the election. 

The fact that both Vice President Kamala Harris and former President Donald Trump included home health care proposals in the late stages of their campaign made it clear that it’s a topic of interest—and one that’s meaningful to Americans, a group said on a webinar offered by the National Alliance for Care at Home (The Alliance) and Axxess, “2024 Post-Election Analysis: Impact on Business, Healthcare and Care Delivery in the Home.”

“Supporting people in their homes is something all people care about,” said Steve Landers, CEO of The Alliance. 

In the short term, the election results will impact advocates’ legislative strategy, said Andrew Woods, chairman of the Liberty Partners Group and Washington-based lobbyist who has worked on behalf of home-based care for many years. While advocates have been focused on legislation in the House and Senate to mitigate cuts to home health payments, the sector may have to pivot quickly to ensure it is included in a small year-end budget package before the holiday recess, Woods said.

In the long term, Woods said that homecare should be well positioned. Assuming the Senate flips from a Democratic to a Republican Party (GOP) majority—as was being reported at press time—Sen. Susan Collins of Maine, a longtime champion of the industry, will become chair of the Senate Appropriations Committee. Collins becoming chair of the committee would mean that she’ll be in a strong position “to advocate for our positions,” Woods said.

Anticipating that party flip in the senate, advocates have been meeting over recent months with Sen. Thom Tillis (R-NC), who Woods said has agreed to be the lead Senate Finance Committee Republican on home health issues moving forward. Woods said Tillis is well respected even among Democrats on Capitol Hill, making him a strong ally.

“I think we’re in really good shape in the Senate,” Woods said.

In the House of Representatives, homecare stalwarts Reps. Terri Sewell, a Democrat from Alabama, and Adrian Smith, a Republican from Nebraska, held onto their seats. GOP incumbent Vern Buchanan, a Florida Republican, is also expected to play a role.

“It might be easier to work on our issues with a Republican trifecta (that is, control of the House, Senate and White House) because Republicans like Tillis and Buchanan will look at home health and they’ll see the savings we generate for the (Medicare) trust fund,” Woods said.

E.J. Dionne, a fellow at the Brookings Institute, syndicated columnist for the Washington Post and frequent political commentator, said control of the House of Representatives is still to be determined, but “whoever wins the House, the margins will be very narrow.”

Whoever is in power, Dionne said, it’s likely the coming Congress will have a big debate over health care in general—and senior care will be part of that. 

“I think long-term care and homecare are issues that are going to be with us as we baby boomers age,” Dionne said.

But at the same time, Dionne said that the political and budget climate may be so difficult and hostile that it could take time to get things moving.

Ander Crenshaw, a former Republican congressman, said that a Trump administration and a Republican Senate would likely bring a focus on efficiency, debt relief and business methods—and homecare fits perfectly into that.

The new president is “going to bring in a lot of new people and, hopefully, a lot of the people will be market-driven, consumer-oriented; they’ll be anti-regulation,” Crenshaw said. “That’s what I’m encouraged about.”

Landers said that there are three main examples of regulation failures that are hurting the in-home care sector right now:

• The implementation of the home health payment rule based on a flawed approach to budget neutrality.
• The 80/20 rule on direct staffing payments in Medicaid.
• The hospice special focus program intended to identify and improve poor quality providers that has been “a toxic, regulatory failure,” he said.  

“The regulatory piece has been hamstringing the industry for so many decades,” said Deborah Hoyt, senior vice president of public policy at Axxess and co-host of the event.