WHITE HOUSE:

While the President spent the early part of the week campaigning, the White House focused on several initiatives of interest, including new global efforts on climate change, as well as a new national security memorandum to strengthen the security of United States agricultural production and protecting the federal supply chain. One specific item of note:

• In honor of Veteran’s Day, the White House posted a fact sheet outlining all the different efforts they’ve taken to assist military veterans. As many facilities work with veterans, it’s a valuable resource to explore.

CONGRESS & ELECTIONS:

Before we get to the elections, one note from the Senate that wasn’t included in last week’s digest:

• Senator Warner released a report on cybersecurity threats against healthcare providers. You can access a complete copy of the report here (PDF).

There’s a tremendous amount to unpack from this week’s elections. With the announcement last night that Senator Cortez Masto won reelection in Nevada, the Democrats have secured at least 50 seats in the Senate through 2024, regardless of what happens in the Georgia runoff on December 6^th. Although the House remains up in the air, the latest expectations are that the GOP will end up with a very slim majority in the House (around 220 seats; 218 is the majority). Obviously, the news over the last few days has been an election post-mortem, but quite a few key points specifically relevant to the long-term care industry:

• First and foremost, practically, with the poor performance by the GOP, Congressman McCarthy’s path to Speaker is more tenous (although still likely). There are also mounting challenges to Leader McConnell in the Senate.

• Dems outperformed everyone’s expectations, but as we mentioned many times, a key factor appears to have been the low candidate quality on the part of the GOP, something that Democrats capitalized on. As 538 notes, in races where one candidate was more “qualified”, i.e. not an extreme far-right or left candidate, the public supported the more “normal” candidate. Voter preference for moderate candidates also played out at the state level in gubernatorial races.

• Importantly, many of the extreme candidates who fared poorly were hand-picked by former President Trump, prompting immediate recriminations from inside the GOP. Governor DeSantis’ spectacular performance is leading to intense speculation for 2024.

• While the focus was at the federal level, the GOP drastically underperformed at the state level as well, with 4 state chambers flipping from R to D (the Michigan House & Senate, the Minnesota Senate & the PA House) with a few more still possible.

• Although much has been made about the GOP underperformance, they did pick up some seats in tough areas, including New York, highlighting the fact that election results were very regional.

• A few important state measures passed on Tuesday as well, not including the very public protection of abortion rights by voters (which may have played a role in the federal outcomes):

• Arizona overwhelmingly passed prop 211, which requires more disclosure in dark money contributions in state races and may serve as a model for other states.

• South Dakota voters approved Medicaid expansion continuing a trend of voters in red states (such as Missouri, among others).

• Nebraska voted to increase the minimum wage, while the vote for Nevada is still being counted.

• Finally, yet again, the pollsters are going to be involved in soul-searching as to why their results continue to not represent the outcomes on election day.

AGENCIES:

HHS considers today (Monday, November 14^th) to be the 60-day threshold to notify the public if they will end the PHE. Although NOT yet confirmed, it would appear likely that HHS is going to grant another extension. Many important waivers and state Medicaid temporary increases are tied to the PHE. We covered several implications of how a PHE extension affects the SNF community back in SNF Digest #5.

OTHER:

A few other notes from the week:

• The Supreme Court heard the Indiana case we mentioned several months ago this week that has significant implications for Medicaid and mostly impacts facilities in IGT/UPL states. For the lawyers here, while impossible to predict the outcome, court watchers think that that the outcome will be very narrow.

• z-INTEL Co-Founder Marc Zimmet posted an analysis of how Medicare Advantage rates impacts the SNF reimbursement market.

• In an innovate effort to tackle the growing crisis of medical debt, the city of Toledo, OH voted to use $800,000 of ARPA funding to work with a non-profit to purchase and forgive medical debt for folks who live in Toledo. This can serve as a model for other cities and states to follow.

• Kaiser Health News did a deep dive into homelessness among seniors.

• NPR explored the long-term care plans, or more accurately, the lack thereof, for adults with disabilities.

• Governor Hochul signed an executive order establishing New York State’s Master Plan on Aging. Here’s an explainer on what is expected to be included.

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