Category Archives: SNF

The 2012 Election Aftermath Analysis

Looking past the fact the 2012 election was a GOP debacle, and the allegation — fair or not — that the GOP has a “polling problem,” the election result is best analyzed by a Resurgent Republic analysis authored by by Whit Ayres, Jon McHenry and Luke Frans. Charlie Cook said this analysis, specifically, is the best he has yet to peruse.

The basics of the analysis:

The 2012 election marks the year when the inexorable march of demographic change caught up with the Republican Party. While multiple factors led to President Obama’s reelection, none was as important as rapidly increasing demographic change in the American electorate. Mitt Romney won white voters by a landslide, 59 to 39 percent, in the process achieving the highest percentage of the white vote of any Republican
challenging an incumbent president in the history of exit polling. Yet that was not enough to craft a majority of the popular vote.

Resurgent Republic’s 2012 post-election survey polled 1000 likely voters nationally, starting on the night of the election, November 6, and concluding on Thursday, November 8. The results were weighted to conform to the popular vote outcome of 50 percent for Obama and 48 percent for Romney. Following are key highlights of the survey. Full results are available at resurgentrepublic.com.

Structure of the Electorate from Exit Polls

1. The 2012 electorate contained the smallest share of white voters and the largest share of nonwhite voters in American history. White voters constituted 72 percent of the electorate, down from 74 percent in 2008, 77 percent in 2004, and 81 percent in 2000.

African-Americans made up the next largest share at 13 percent, the same as 2008, and up from 11 percent in 2004 and 10 percent in 2000.

Hispanics constituted 10 percent of the electorate in 2012, compared to 9 percent in 2008, 8 percent in 2004, and 7 percent in 2000.

Asian voters made up 3 percent of the 2012 electorate, an increase from 2 percent each in 2008, 2004, and 2000.

2. Mitt Romney won a larger share of the white vote than either John McCain or George W. Bush. Romney defeated Obama by 59 to 39 percent among whites, compared to McCain winning whites by 55 to 43 percent over Obama in 2008, while Bush won whites by 58 to 41 percent over John Kerry in 2004 and by 54 to 42 percent over Al Gore in 2000.

3. Mitt Romney won white voters in almost all demographic groups, usually by substantial margins. Romney’s campaign was extremely successful at appealing to white voters across the board, and won almost all white groups except Jewish voters.

Predictable DC Drumbeat that Romney is Toast

If one listened only to the Washington Beltway echo chamber this week, the presidential campaign is over.

Not only did Romney ‘mishandle’ the sacking of the U.S. embassy in Libya, but he’s also “lost Ohio” and thus the election because of several polls confirming the President maintains a small “lead.”

And that’s one of the biggest flaws of the reporting and armchair commentary.

When one sees reporting that says Obama ‘leads’ Romney 47%-45% is state X, that’s actually terrifying news for any incumbent. This is the case in any number of states where Obama ‘leads’ Romney but is not close to 50%.

This is what GOP pollster Whit Ayres correctly calls the incumbent’s ‘never-never land of 47%, 48% and 49%.” Hitting 50% +1 for Obama will be a continual uphill fight in a variety of battleground states like Florida and Virginia — no matter what we hear and see now — due to the economy and horrendous right track/wrong track #’s.

Granted, Romney still has quite a bit to do in terms of even getting to the point of possibly closing the deal — he’s indeed behind, still needs to package his agenda more succinctly, and the ruthlessness of the Obama campaign has kept him back on his heels.

But still, campaigns change quickly.

With debates and so many surprises left in store, anything can happen — and Romney is very much in the thick of the contest, no matter what one sees from DC talking heads, most of whom, pathetically, have never even worked on a campaign.

POS/Hart Survey Underscores Potency of Attacking Lawmaker Votes to Cut Medicare

As the U.S. Senate and House of Representatives begin making crucial budgetary decisions for FY 2013, a recent survey conducted for the Alliance for Quality Nursing Home Care by Public Opinion Strategies and Hart Research Associates underscores the saliency political operatives find in attacking incumbents who expose themselves to such attacks by supporting Medicare cuts — in this case to nursing homes.

The survey (January 26-30, 800 RV’s [700 landline/100 cell] +/- 3.46%) finds 82% of RV’s oppose reducing Medicare funding for seniors’ nursing home care; 90% say funding for U.S. nursing home care should either “remain the same” or “increase”; and, interestingly, a full 69% support the concept of phasing-in a controversial 2011 Obama Medicare regulation that reduced Medicare funding by 11.1% all at one time.

With Republicans and Democrats both suffering major losses in back to back congressional elections — as each side in successive cycles absorbed attacks ads accusing incumbents for cutting seniors’ Medicare benefits — it’s no surprise both sides are circling each other warily as the FY 2013 budget negotiations take shape.

Private polling done for a health care provider group in Texas last year, as well as polling conducted for the Texas Tribune, found cuts to seniors’ nursing home care are among the most unpopular cuts of nearly a dozen options mentioned. This is not lost on ad makers, pollsters, campaign operatives and lawmakers themselves.

Health Providers Must Emphasize Cost-Efficiency in FY 2012 Budget Debate

Capitol Hill lawmakers, regulators and the media have heard it all before at the onset of the annual budget dance: No cuts to Medicare — especially as state budgetary chaos has eroded Medicaid funding stability. With the 2012 budget debate about to get underway on Capitol Hill, the nature and composition of the new Congress — with an eye on spending cuts — will require health care providers of every stripe to emphasize how they’re part of the solution when it comes to saving tax dollars.

As Skilled Nursing Facilities (SNFs)  are the dominant provider of Medicare post-acute services, a recent Health Affairs article, “The Revolving Door of Rehospitalization From Skilled Nursing Facilities,” corroborates the general viewpoint that care quality and spending efficiency can be enhanced by policy reforms.

States the article, authored by Vincent Mor, Orna Intrator, Zhanlian Feng, and David C. Grabowski: “Payment incentives in Medicare do not encourage providers to coordinate beneficiaries’ care. Revising these incentives could achieve major savings for providers and improved quality of life for beneficiaries.”

An Avalere Health study conducted for one major provider group, the Alliance for Quality Nursing Home Care, echoes this sentiment in terms of possible savings: “Health policy experts view many of these [rehospitalization] incidents as preventable — to the tune of potentially $12 billion in annual savings, according to the Medicare Payment Advisory Commission (MedPAC).”

It further suggests “studying the sector can provide a unique window into addressing rehospitalizations, and that potential strategies to reduce this growing phenomenon can help sustain ongoing improvements in nursing home care, in addition to saving tax dollars.”

The first quarter 2011 health policy debate — with its inherent savings discussion — will be fertile ground upon which to advance SNFs’ and others’ public policy objectives in terms of making “savings” a central messaging thrust. Gordon Hensley

For SNFs, FMAP Extension Badly-Needed as State Medicaid Budgets Wither

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Putting aside the various policy benefits and liabilities associated with the respective Senate and House health care reform bills, currently buried in a snowdrift of indecision somewhere on Capitol Hill, the House bill’s temporary federal medical assistance percentage (FMAP) increase is a vital necessity to Skilled Nursing Facilities (SNFs) nationwide struggling with the most basic of business crises: Cash flow.

Specifically, the House bill extends the temporary 6.2% FMAP increase from the American Reinvestment and Recovery Act (ARRA) through June 30, 2011. While the provision is not in the Senate bill, President Obama’s FY 2011 budget proposal includes the FMAP provision.

SNFs are arguing, correctly, that disastrous state fiscal conditions and the subsequent pinch on state Medicaid funding merits more temporary federal help, as the sector’s operating margins are the lowest of any provider group. Providers at the state level are out early, notably in Texas, making the case that SNF funding is being squeezed much as it was a decade ago in the wake of 1997 BBA implementation. The result, then, was 15-20% of the SNF sector driven into bankruptcy, worsening patient care and many lost jobs.

In testimony yesterday at a Health and Human Service Commission (HHSC) hearing in Austin, TX on what appears to be likely state budget reduction options, the Texas Health Care Association (THCA) warned that any new cuts now to Texas Medicaid payment rates for nursing home care will confront the nursing home profession with what he called “dire financial consequences.”

Tim Graves, the THCA President, noted the Obama Adminstration has already begun to implement $725 million in federal Medicare cuts that went into effect (by CMS regulation) in October, 2009, and said Texas has historically relied upon federal Medicare funding to “prop up the already inadequate funding of state Medicaid rates that have not met the state’s own rate-setting methodology since 1999.”

Graves’ argument is one state lawmakers will and should hear as the state budget debates unfold throughout Spring 2010: “Before we engage in discussions about cutting Texas seniors’ key Medicaid-financed programs, we must look first at the fact nursing homes are already having to deal with a state and federal funding environment that squeezes facilities’ abilities to recruit and retain the high quality direct care staff that make the ongoing provision of quality care possible.”


Medicare Cuts in House Health Reform Bill Politically Unrealistic

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The health care reform bill (HR 3962) that passed in the U.S. House of Representatives by the slimmest of margins last week was dealt a serious setback this weekend when the Centers for Medicare and Medicaid Services (CMS) released a new study that, according to the Washington Post, “found Medicare cuts contained in the health package approved by the House on Nov. 7 are likely to prove so costly to hospitals and nursing homes that they could stop taking Medicare altogether.”

The lede of the Post story, entitled, “Report: Bill Would Reduce Senior Care” is brutal:

A plan to slash more than $500 billion from future Medicare spending — one of the biggest sources of funding for President Obama’s proposed overhaul of the nation’s health-care system — would sharply reduce benefits for some senior citizens and could jeopardize access to care for millions of others, according to a government evaluation released Saturday.

Following the taxpayer-funded abortion controversy surrounding the Stupak amendment, and the Democratic leadership’s need to retreat in order to pick up moderate Blue Dog support, the CMS study has enormous implications in terms of how a final bill will be shaped in Conference once a Senate bill clears the floor.

The fact the Post reported the House bill “would sharply reduce benefits for some senior citizens and could jeopardize access to care for millions of others,” has provided the GOP with yet another weapon to hammer marginal House and Senate Democrats, and another reason to vote against or be extremely leery of a final bill that slashes seniors’ benefits.

The CMS study is somewhat helpful to the Skilled Nursing Facility (SNF) sector’s effort to help ensure the $23.9 billion, ten year cuts contained in HR 3962 to help finance the package could be pushed downward more in line with the existing Senate Finance Committee package crafted by Sen. Max Baucus (D-MT).

Interestingly, in regard to the whole notion of “cuts” to Medicare needed to finance any final reform bill, Sen. Kent Conrad (D-ND) engages in a bit of selective memory by stating, ”I think we’ve got to be very careful about our language. There are no cuts in any of these bills. There are reductions in the increases that they’re scheduled to receive” (“State of the Union,” CNN, 11/15).

In 1996, when Republicans sought to trim the growth in Medicare spending, much like what is being attempted now by the Democrats, GOP Senate and House candidates — as well as presidential nominee Bob Dole — were skewered for “cutting” Medicare. Besides the burden of defending the steep costs of a health care bill, House and Senate leaders will inevitably be forced to deal with the political implications of cutting Medicare spending — or, more accurately, trimming the growth of the program. This will become a more significant issue once a bill, presumably, makes it to Conference. The bottom line it very unlikely the high level of Medicare spending reductions providers now face in the House bill will survive.