WASHINGTON, DC — Regardless of who wins the presidential election, senior living providers should not expect big changes any time soon regarding so-called entitlement programs such as Medicare, Medicaid and Social Security; federal regulations; or immigration policy, former Health and Human Services Secretary Michael Leavitt said Monday during the keynote session of the National Investment Center for Seniors Housing & Care 2024 Fall Conference.
Leavitt, a Republican who was HHS secretary under President George W. Bush from 2005 to 2009, said he has “no idea” who will win the presidency, but he said “there’s a 90% to 95% chance we’re going to end up with a divided government” in the legislative branch, with a Republican-majority Senate and a Democrat-majority House of Representatives.
The political will to “deal with” solvency issues related to programs such as Medicare, Medicaid and Social Security may not exist right now, Leavitt said in an interview with Chuck Todd, NBC News chief political analyst.
“It’s one of those issues that will likely have to be solved in the context of a crisis. …There’s definitely a point where this catches up, and there’s going to be a crisis in that moment,” said Leavitt, who heads consulting firm Leavitt Partners now.
When he entered the workforce in the mid-1970s, Leavitt told Todd, there were 4.6 workers per Medicare beneficiary. Now, it’s “just above 2” workers per beneficiary, he said.
“So we’ve got much larger entitlement expenditures, substantially more beneficiaries, and half the workers,” he said. “That’s where the deficit is coming from, so that pressure is going to continue.”
In the meantime, he agreed when Todd said that the programs probably will be expanded over the next four years, regardless of who is president.
“You can certainly see the makings of that, and I think it’s in the category of, how do you support families during a time when they’re bearing a huge — ironically — burden from their support of Medicare” as their parents and grandparents age, Leavitt said.
The political will to address solvency issues, he added, may arrive with the generations that are paying more into the system than they may get out of it.
What Chevron overturning means
Regarding the recent Supreme Court ruling that overturned the longstanding Chevron doctrine, via which courts deferred to a federal agency’s “reasonable” interpretation of ambiguous laws passed by Congress, Leavitt said that the move could mean less regulation in the short term and, over time, more regulatory decisions moving to the states.
Legal experts predict that the 6-3 High Court decision, which came in late June in Loper Bright Enterprises v. Raimondo, will affect almost every US agency, among them the Department of Labor and its Wage and Hour Division and Occupational Safety & Health Administration, the US Equal Employment Opportunity Commission, the National Labor Relations Board and the Centers for Medicare & Medicaid Services, all of which have issued several rules affecting senior living providers.
Members of Congress, Leavitt said, may be able to write more detailed legislation, but they will have issues being able to agree on what those details should be.
“So what we’re going to see is, over the next five years, the Supreme Court is going to have to actually define what they mean … and it’s going to mean, in my judgment, a lot less regulatory intervention and a lot slower movement of government,” he predicted.
“I would not worry … about an immediate change in any regulation based on Chevron,” Leavitt added. “It’s not going to happen. It’s going to take a long time.”
But a “lighter touch” from the federal government does not mean that “we’re going to be without regulation,” he said, adding that, ultimately, “Congress is going to find a way to write the statutes in a fashion that gives the executive branch what they need. It’s just going to take some time for them to adapt.”
Over the long term, said Leavitt, who was the governor of Utah from 1993 to 2003, the ruling is “a good idea” that will push some regulatory decisions to the states. “I think one of the things Congress can do is to say, ‘Let’s let the space decide,’ and we’ll see a lot more of that,” he said.
State governments are “substantially more functional than the federal government,” Leavitt said, so having more decisions made at the state level would be “a very positive thing.”
‘A little more optimistic’ on immigration
Speaking about immigration reform, which many long-term care providers see as a solution to perennial workforce challenges, Leavitt said that the expected divide in the legislative branch could bring an outcome that pleases providers.
“I’m a little more optimistic on immigration, because the practical impact of it is beginning to affect all society, and both sides of the political spectrum have dealt with its downsides,” he said. “The formula for an immigration solution is probably to have a divided government, where a center begins to form and pressures begin to come,” either when an election is far off or is getting close “and people want to solve it.”
By 2040, senior loving will have 3 million job openings, and long-term care as a whole will have 20 million, Argentum previously calculated.
More than 2,800 people registered for the 2024 NIC Fall Conference, NIC President and CEO Ray Braun said at a press briefing preceding the afternoon sessions of the meeting’s first day. The conference continues through Wednesday.
