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The battle over immigration reform

November 18, 2014
by Bob Gatty
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Bob Gatty

A massive netting of scaffolding encircles the U.S. Capitol dome these days as workers toil to restore its tarnished luster. But no amount of scrubbing and scraping can undo the nasty, vitriolic atmosphere that has imbedded itself inside the Capitol’s hallowed chambers.

In fact, since the elections, all indications are that virtually any meaningful action seems destined to be ensnared in a worsening web of rancor and animosity that some extremists even have suggested should result in the impeachment of the president.

It is in this difficult atmosphere that representatives of the long-term care (LTC) industry must work as they seek to inform lawmakers about the importance of their industry to those in its care and to generate support for policies and laws that could help provide business stability and improve patient/resident care.

Come January, Republicans will have the biggest majority in the House of Representatives in decades and will have solid control of the Senate. The only thing the GOP will not have is enough votes to break a filibuster by Democrats or override a veto by President Obama.

And now, in the lame duck session, those Republicans, led by House Majority Leader John Boehner (R-OH) and Senate Minority Leader Mitch McConnell (R-KY) are giving no quarter, while President Obama appears determined to push his agenda, regardless.

Although many issues of importance to the LTC industry will play out over the next two years, influenced by the GOP majority determined to slash spending, including in Medicare and Medicaid, and either eliminate or decimate the Affordable Care Act, one major issue is dominating the news now and in which the industry has a stake: immigration reform.

The Obama administration has developed a 10-point immigration plan that it intends to implement by executive order. Boehner and McConnell have warned him against doing so, and some right-wingers, such as columnist Charles Krauthammer, have said his planned action is “impeachable.”

Under the president’s draft plan revealed Nov. 13, deferred action for illegal immigrants who came to the United States as children will be expanded, allowing upwards of 4.5 million illegal immigrant adults with U.S.-born children to stay. Another portion will expand deferred action for young people if they entered the United States before they were 16 before Jan. 1, 2010, to stay. That move would make nearly 300,000 illegal immigrants eligible.

Although those provisions are strongly opposed by anti-“amnesty” lawmakers, they could help increase the pool of legal workers available in the United States, a result that could certainly benefit nursing homes and other facilities that struggle to fill patient care positions that are subject to constant turnover.

The American Health Care Association (AHCA) has been a strong advocate of immigration reform, testifying before Congress in March 2013 and urging action to ease the way for immigrants to be legally employed.

“We have critical staffing needs,” testified Fred Benjamin, chief operating officer of Medicalodges Inc. before the House Education and Workforce Committee’s Subcommittee on Workforce Protections. “There are chronic shortages throughout the nursing home industry. If you are in the business of caring for our nations’ elderly, whether you are for-profit, non-profit or government-managed, it is a daily struggle to find enough dedicated caregivers to care for the people in your charge.”

Benjamin said the shortage of labor and difficulty in finding staff is cited as a major reason by many existing workers at his company who seek alternative employment. “We lose some of our best managers during this period of time when their skills and compassion are crucially needed,” he told lawmakers. “Our dedicated staff do a very hard job for a wage that is as much as we can pay, but never enough, in my opinion, for the service they provide. Without these caregivers, our seniors will suffer,” he asserted.

Benjamin pointed out that the industry is “almost completely dependent on the government” for payment for services, and thus cannot increase its prices to generate more income to pay higher wages. Nearly 80 percent of residents are Medicare or Medicaid beneficiaries, and of the remaining 20 percent, 17 percent are spending their life savings until they can qualify for Medicaid, he explained, adding that only three percent have private insurance.

Clearly, with such a dependency on Medicare and Medicaid, any ultimate reforms of those programs initiated by the new GOP-controlled Congress will have a major impact on the industry. That is a topic to be addressed in 2015 when the dust settles, however.

Today, the immigration reform debate is raging, having become not only a giant hot potato but also a test of wills between Congress and the White House, between Republicans and Democrats.

One bright spot exists in all of this, however, according to some seasoned observers: If President Obama succeeds in implementing his plan via administrative order, then it is probable that Congress, most likely next year, will enact a broader reform plan devised by Republicans. That should give the LTC industry an opportunity to weigh in and, perhaps, to influence the provisions of that legislation.

How that will play out, however, remains to be seen.

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