The 2022 midterm elections likely mean no new initiatives focused on older adults and their families will pass Congress in 2023. The slim Democratic majority in the Senate, combined with what is likely to be narrow Republican control of the House, will make it very difficult for Democrats to approve new programs or for the GOP to roll back recent changes to the Medicare drug program.
The Biden administration’s ambitious plan to support frail older adults and their families is dead, at least until 2025. But a divided Congress also means major changes in Medicare drug costs that Congress passed this year will survive, at least for now.
While few legislative initiatives are likely, watch for an aggressive ongoing regulatory push on nursing homes from the Biden administration.
Doing Nothing
More than either party wanted to admit in the campaign, next year’s legislative agenda is likely to be driven by the state of the economy rather than ideology. If inflation remains high, Republicans will have some leverage to cut government spending. But if the economy slows, the Democratic Senate is likely to reject spending reductions.
But House Republicans will be able to block many Biden administration initiatives simply by doing nothing. Biden failed to convince a Democratic Congress to enact many of his ideas, such as paid family leave, extensive new funding for Medicaid home and community-based services (HCBS), and significant increases in spending for a wide range of senior services funded through the Older Americans Act. There is no chance the coming divided Congress will approve any of these initiatives.
Nursing Home Regulation
The Biden administration will, however, push a regulatory agenda that could significantly affect nursing homes. The biggest: Tough new minimum staffing requirements for facilities that take payments from Medicare and Medicaid. The Centers for Medicare & Medicaid Services (CMS) also is likely to require more disclosure of nursing home ownership and must finalize a proposed crackdown on very poor performing facilities.
The Administration also must decide whether to allow the pandemic-era Public Health Emergency to expire this spring. When it does, a wide range of rules granting operating flexibility to nursing homes will expire.
In Congress, lawmakers are likely to spend much of 2023 in a nasty battle over federal spending. Republicans have vowed deep cuts in domestic spending and some already have threatened to both shut down the government and end its ability to borrow money if they don’t get their way. This battle likely will come to a head next Fall. Until then, expect little activity in the House beyond GOP investigations into the Biden administration and Biden’s son, Hunter.
Here is a brief rundown on key issues that will affect older adults and their families.
Social Security
Yes, some Republicans campaigned on cutting the federal retirement program. The program will be unable to pay full benefits in just 11 years and something needs to be done. But there is no chance Congress will make substantial reductions in Social Security in 2023.
The GOP-controlled House could pass some benefit reductions but getting those cuts through a Democratic Senate will be impossible. Besides, Biden would veto any bill that does pass. Many Republicans would be loath to make a vote that will haunt them for years, especially if that vote turns out to be meaningless.
Medicare Drug Pricing
Similarly, the GOP House could try to reduce Medicare benefits but no plan would pass the Senate. Earlier this year, the Democratic-controlled Congress approved a series of measures aimed at lowering prescription drug prices for Medicare beneficiaries. Most provisions are not scheduled to take effect until 2023 and beyond. For example, the headline feature that allows Medicare to negotiate prices with drugmakers won’t even begin to take effect until 2026. A divided Congress won’t accelerate this timetable but it won’t repeal the reforms either.
Older Americans Act Funding
The OAA is the umbrella federal program that funds a wide range of supports for older adults and their families—everything from home-delivered meals to elder abuse prevention, caregiver supports, and information services. For the past decade, these programs have been funded at roughly $2 trillion annually, except for big increases during 2020 and 2021 in response to the pandemic.
In fiscal year 2022, Congress allowed funding to drop back to pre-pandemic levels because it was unable to agree on big increases proposed by the Biden administration. The GOP majority in the House can block any new increases next year by doing nothing. While many Republicans want to make spending cuts their major legislative priority this year, the most likely outcome will be a budget frozen at this year’s levels.
Retirement Savings Incentives
The House passed a broad bipartisan retirement savings bill last spring and the Senate Finance Committee developed a slightly different version a few months ago. A compromise bill could pass in a post-election session this year or sometime next year.
CHRONIC 2.0
In 2018, Congress for the first time allowed Medicare Advantage managed care plans to offer home-based services to members with chronic medical conditions. A bipartisan group of senators quietly have been developing an expanded version of that bill. Despite the partisan acrimony, the new plan could surface next year.
A deeply divided, highly partisan Congress will accomplish little in 2023. And support for older adults and their families will be caught in that gridlock.