Overtime Rule, Value-Based Care and More: What Trump Means for Senior Living

In just under two months, president-elect Donald Trump will take his seat in the Oval Office.

Senior living providers, along with everyone else, are waiting to see what the Trump presidency means for them.

In waiting for a President who has been light on policy specifics, informed speculation is all that’s possible.

The Overtime Rule

One big issue for senior living operators is certainly the Department of Labor’s overtime rule, which goes into effect on December 1 — but which may face a cold reception from the new administration.

He could try to repeal it himself, or through legislation, but that process could take a while — if it works at all. From Politico:

In theory, says Judy Conti, federal advocacy coordinator for the National Employment Law Project, the Trump administration could propose a new regulation undoing the old one. But that would require a notice and comment period that could last a year or more, and to comply with the Administrative Procedures Act Trump’s Labor Department would have to demonstrate a change in economic circumstances.


Congressional Republicans could introduce legislation to block the rule — but that, Conti said, wouldn’t likely survive a filibuster challenge from Senate Democrats.

Some Republicans might not go for a repeal, either, because the overtime rule polls well across party aisles — a majority of Republican voters like the rule.

The two most likely scenarios:

  1. The rule gets scaled back, but not repealed entirely. For example, the salary threshold for overtime could get rolled back.
  2. The rule is here to stay.

Value-Based Care

The Affordable Care Act as we know it very clearly appears to be in jeopardy — but that doesn’t necessarily mean a repeal of the specific provisions that so heavily incentivize value-based care.

Lawmakers in 2015 showed serious bi-partisan support for Medicare payment reform when the Senate passed MACRA by a 92-8 margin.

Over at RevCycle Intelligence, Jennifer Bresnick has penned a lengthy and comprehensive guide to how Trump might — or might not — affect value-based care. An excerpt:

The overwhelming approval of MACRA, coupled with across-the-aisle commitments to health IT development issues ranging from cybersecurity and interoperability to timeline changes easing the burdens of meaningful use, indicate that lawmakers are more united than divided on the importance of healthcare payment and technology reform.

This likely bodes well for providers who have made financial commitments to electronic health records, population health management tools, and other health IT infrastructure intended to help them succeed in a value-based environment. 

None of these investments will be wasted – in fact, they may help prepare providers for a very lean operating environment after the likely removal of Medicaid expansion funds and a potentially sharp increase in self-pay patients keen to avoid unnecessary services, costly errors due to improperly informed decisions, and repetitious tests.

The whole article is worth reading.

Affordable Senior Housing

One of Trump’s clearest policy proposals has been to cut non-defense spending by 1 percent every year. That means affordable senior housing could be on the chopping block, via cuts to programs offering Section 8 housing, rent assistance or tax credits.

Diane Yentel, president of the National Low Income Housing Coalition, wrote an open letter speculating what housing policy might look like under the new Congress:

We will see efforts to lower domestic non-defense spending and to implement much of Speaker Ryan’s anti-poverty agenda, which could include welfare reform-type changes such as work requirements and time limits to all anti-poverty programs. Congress will move quickly to enact comprehensive tax reform – legislative drafts are already being written – that dramatically lowers corporate and individual tax rates by reducing or eliminating tax expenditures and credits, possibly including the Low Income Housing Tax Credit.

Reform of the mortgage interest deduction (MID) is on the table as another “pay-for” to lower tax rates. We’ll need to pull out all the stops to ensure that savings from MID reform are reinvested into affordable rental housing programs. The Republican Congress may also work towards dismantling Fannie Mae and Freddie Mac.

That brings us to the national Housing Trust Fund, which may be threatened from multiple angles. I expect efforts by House Republicans to eliminate the HTF to resurface quickly, and we could again see appropriators attempt to fill HUD budget holes with HTF dollars. FHFA Director Mel Watt could be replaced by someone who shares former FHFA Director DeMarco’s view that contributions to the HTF should be suspended while Fannie and Freddie remain in receivership.

Of course, much depends on who Trump appoints to lead the Department of Housing and Urban Development (HUD). Yentel covers the cast of candidates:

There are a few former HUD alumni from the Bush administrations working on the transition team, and several names have moved to the top of the short list for HUD secretary. Among them are Pam Patenaude, president of the Terwilliger Foundation for Housing America’s Families, and former Senator Scott Brown, who also serves on the Terwilliger Center’s executive committee. Both Ms. Patenaude and Senator Brown have deep knowledge of, experience with, and proven commitments to affordable housing. Both would be excellent choices.

Also on the shortlist for HUD secretary, however, are Westchester County Executive Rob Astorino, who has spent over a decade fighting his obligations under the Fair Housing Act, and Ken Blackwell, a senior fellow at the Family Research Council. Who President-elect Trump decides to nominate will give us important insights into his priorities for housing programs.

Read the full letter here.

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