A Dems Wish List You Better Know

The DC news outlet Politico obtained the game plan from Democrats on what they would like to do legislatively if they win back Congress next month, titled, “Cost-of-Living Healthcare Working Group Memo on Democratic Healthcare Action for the First 100 Hours, First 100 Days, and First Year of the 120th Congress.”

As some sports announcers like to say, “if the season ended today, X team would be in the playoffs.” Well, for politics, if the elections were held today and polls correct, the Democrats would win back the House and the Senate. And that means change of some magnitude in Washington, DC, and possibly for skilled nursing providers.

Of course, the presidency is not up for grabs next month, so any of the goals Democrats have for changing SNF-world will likely be up against a Republican White House and the veto President Trump holds.

Staffing Standards

Among the measures in the game plan, the one SNFs are likely watching the closest is language on the staffing mandate. Just because Democrats want to act on this area, any legislative win and actual implementation is a big question mark, and it is assumed even if a mandate made it through Congress, President Trump would end it with a veto.

Many sector watchers see the 2027-2028 period as a stalking horse time frame, setting up real action on mandates if a Democrat wins the presidency in 2028 and had sway or control of Congress.

Regardless, in the Democratic memo, they call for a staffing mandate of 4.1 HPRD (versus the 3.48 HPRD under the Biden-era mandate). The agenda specifically identifies H.R. 8100, the Safe Staffing Saves Lives Act, introduced by Rep. Lloyd Doggett (D-Texas), as the proposed legislative vehicle.

The quick details are that the Doggett bill would require Medicare- and Medicaid-certified nursing homes to provide at least 4.1 HPRD, along with an RN physically onsite 24 hours a day, seven days a week, with these requirements starting in 2029.

REITS

Beyond staffing, the Democrats are eyeing a proposal to restrict private equity and REIT ownership of hospitals and SNFs. The Democratic memo identifies H.R. 7920, the Take Back Our Hospitals Act of 2026, introduced by Rep. Mary Gay Scanlon (D-Pa.), as the principal legislative vehicle.

Just recently, a similar bill was reintroduced in the House.

Unlike proposals that focus exclusively on ownership disclosure or enhanced transparency, this Scanlon legislation would prohibit Medicare payments to hospitals and SNFs owned or controlled by certain investment firms, including private equity funds and REITs.

The Scanlon bill's definition of a covered firm explicitly includes three categories: private equity funds, corporations owned or controlled by private equity funds, and REITs. The definition of a private equity fund references certain investment vehicles exempt from registration under the Investment Company Act of 1940, while the definition of a REIT references Section 856 of the Internal Revenue Code.

The legislation does not explicitly prohibit REITs from owning nursing home real estate, it would prohibit Medicare payments to facilities determined to be owned or controlled by a covered firm or its affiliates.

There are other components in the Democratic memo that may please SNFs, like provisions on Medicare Advantage plans. The November 3 vote will tell which way many of these proposals go moving forward.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.