Private equity firms have discovered the goldmine that is long-term care facilities, especially with the Baby Boom population soaring into old age. The more people eligible for more home care, the fewer going into the nursing homes that have proved so lucrative. The House Ways and Means Oversight Subcommittee held a hearing last month on what subcommittee chair Rep. Bill Pascrell described as “the growing control of the health care system by Wall Street and private equity firms, particularly in long-term care facilities.”
“In 2020, private equity investment in the health industry topped $66 billion, a 20 percent increase in one year,” Pascrell said, pointing to research that has found that “nursing homes bought by private equity are linked with higher patient-to-nurse ratios, lower-quality care, declines in patient outcomes, weaker inspection performance and increased mortality rates.” One study of 1,700 nursing homes owned by private equity firms, using Medicare data, “found that patients in a private equity-owned home had a mortality rate 10% higher compared to the overall average.” More than 20,000 seniors died from lower standards of care in these facilities, Pascrell said citing this research, while “private equity owners increased Medicare billing by a whopping 11%.”
Nonetheless, the White House remains committed to keeping this part of the bill alive. “The president included investments in care infrastructure in the jobs plan because he knows they’re vital to [the] well-being of the American people and the economy, and he is absolutely committed to delivering on that,” one of the officials told the Post. As of now, there’s the practical difficulty for leadership in the Senate of figuring how just how they can get it passed with Republicans being in staunch opposition and at least two Democrats—Sens. Joe Manchin and Kyrsten Sinema—being coopted as their “bipartisan” tools.
Senate Majority Leader Chuck Schumer scored a victory a few weeks ago with Senate parliamentarian Elizabeth MacDonough, when she agreed with him that one section of the rules for the budget reconciliation process allows him to bring up previously passed and signed budget resolutions—like the American Rescue Plan COVID relief bill—and amend them and include new stuff. That means that, theoretically, Schumer could pass the infrastructure bills (another plan focusing largely on social infrastructure is expected from the White House soon) with simple majority votes, because these bills aren’t subject to the filibuster.
But Manchin has already signaled that he’ll oppose doing any part of these bills in reconciliation, without Republican votes. Furthermore, the parliamentarian didn’t provide a ton of guidance from MacDonough. So no one seems particularly sure how far that takes them. Schumer said the rules for budget reconciliation “says you can entertain more than an additional reconciliation bill,” and that’s what MacDonough confirmed. “Now how that happens, in what way that happens we have to have discussions with the parliamentarian of course. And we have to decide how to use it,” Schumer said. Meaning the same budget rules that kept the minimum wage increase to $15/hour out of the big COVID-19 relief bill will apply to infrastructure.
Until the Senate figures out what it can do, the House can’t come up with a game plan. “We are waiting on guidance from the Senate as to what that actually means,” House Speaker Nancy Pelosi said last week. “As I’ve said to you before I don’t get involved in their rules and—and they don’t get involved in our rules,” she told reporters.
Meanwhile, Manchin is apparently having some sway. Despite that fact that Biden proposed an exact compromise on an increase in corporate taxes—the Trump tax scam set the rate that had been 35% to 21%, and Biden proposed the exact-in-the-middle 28%—it appears the White House is coming down to Manchin’s top line of a 25% rate. That means a few hundred billion dollars less for Biden to claim to help pay for his full plan. And “good friend” of Biden, Democrat Chris Coons of Delaware, is going around to places like Fox News Sunday to agree with Republicans. “If we come together in a bipartisan way to pass that $800 billion hard infrastructure bill that you were talking about, that I’ve been urging, then we show our people that we can solve their problems.”
On the other side of the Democratic conference, thanks be to Rep. Alexandria Ocasio-Cortez and Sen. Bernie Sanders. They’re introducing their housing and clean energy proposals for a Green New Deal on Monday, proposals that can influence or comprise parts of the eventual infrastructure legislation, particularly since Sanders chairs the Budget Committee. Biden included more than $40 billion in his first proposal to go toward improving public housing infrastructure, while Ocasio-Cortez and Sanders are looking at much more—up to $172 billion over the next ten years to make public housing safe, energy efficient, and to provide living-wage jobs to get the work done.
Again, how this is all going to fit with the proposal Biden has already made, and what the Senate can get passed through Manchin and Sinema isn’t clear. But Sanders is going to use what power he has to make it big. “Probably our best bet would be one bill—and it should be a large bill,” Sanders said in an interview to The New York Times. “I think it’s just easier and more efficient for us to work as hard as we can in a comprehensive broad infrastructure plan, which includes human infrastructure as well as physical infrastructure.”