March 16, 2012 | by Robert Gatty

Harness the power of your residents to promote legislative reform

I’m going to tell you a story about a time many years ago when I worked on Capitol Hill for a Republican congressman from New Jersey, Rep. Ed Forsythe.

Congressman Forsythe was a good man. He was in his late 50s, a gray-haired dairy farmer who wore baggy suits and bow ties. He was serious about his work, including his work as a member of the House Merchant Marine and Fisheries Fish and Wildlife Subcommittee.

I was his executive assistant and press secretary. My job was to keep his name in the news (in a positive way), to help him with political decisions and to serve as his spokesman (among other things.)

One day in the middle of a campaign for re-election, he decided to join his subcommittee on a trip having something to do with whales. I don’t recall the details. But what I do recall is that to make that trip, he couldn’t participate in a previously scheduled debate with his young, dynamic, aggressive Democratic opponent, one Mr. Charlie Yates.

So, he said to me, “Bob, you need to go do that debate.”

“Are you sure?” I asked him. “Are you sure it is more important to check out whales than to show up for a debate in front of a bunch of senior citizens in the middle of a campaign?”

“Yep,” he said. “You go do the debate.”

Well, OK. The only problem was that the debate centered on the big campaign issue as to whether the congressman would support an increase in Social Security payments, contrary to the Republican line of the day—that such an increase would cause inflation. (To put this into perspective, Richard Nixon was president, so that kind of tortured logic was prevalent.)

So I showed up at the debate. My throat was so dry. I croaked like a frog when I spoke. I gave them a song-and-a-dance about why the congressman wasn’t there and I was, but never fear, he was working hard for them.

The senior citizens didn’t buy it. You can’t fool them. And Charlie Yates wasn’t about to let it go.

“It’s great that Bob is here, but he’s not your congressman,” he said. “And, Bob, how does Mr. Forsythe feel about giving seniors a Social Security increase?”

I cleared my throat. “Well, the congressman wants to do everything he can to help seniors,” I croaked, “including making sure that inflation doesn’t get any worse.”

Charlie Yates pressed on. “So you can’t say he supports a Social Security increase?”

I was cornered. Finally, I told them the congressman was still studying the issue.

The seniors booed. The seniors hissed. Charlie Yates glowed.

I tell you this story because senior power is very scary to politicians, and the American Medical Association knows it. It’s one reason why nursing facilities are now on the hook for covering some $6.9 billion of the $21 billion it will cost over the next 10 months so Medicare doctors can avoid a scheduled 27 percent pay cut in this election year.

The AMA has plenty of clout in Washington, as do other physician lobbying groups. They also know how to multiply their influence by convincing their patients to go to war for them when necessary.

And in this world of instant communications and social media, it is far worse than those days all those years ago when I had to debate Charlie Yates. Back then, all I needed to worry about was the wrath of those folks in attendance and what might appear in the local paper the next day. No Twitter. No Facebook. No YouTube of me croaking and sweating at that meeting. Just phone calls and letters. Piece of cake.

But today’s world is different, and for politicians it’s essential, if they want to preserve their jobs, to make sure core constituencies like “senior citizens” don’t get mad, because there can be hell to pay—fast and lasting hell.

So, warned that doctors would stop seeing Medicare patients if the 27 percent pay cut wasn’t killed, Congress took decisive action and approved a 10-month reprieve as part of the Middle Class Tax Relief and Job Creation Act of 2012. Everybody is happy until next January (note, that’s after the November 2012 election), when they’ll have to address the issue again.

One way they did it was to reduce federal payments to skilled nursing facilities and hospitals that collect “bad debt.” Currently, nursing facilities can collect 70 percent of beneficiary cost-sharing expenses from Medicare, and 100 percent of bad debt related to the care of dual-eligibles, those covered by both Medicare and Medicaid.

However, the deal that killed the docs’ pay cut will reduce that to 65 percent in both categories for FY 2013 and beyond. It’s a tough one for SNFs to swallow, given the fact that another 11.1 percent Medicare reduction took effect October 1, 2011.

The agreement, said Alan G. Rosenbloom, president of the Alliance for Quality Nursing Home Care, “ignores the SNF sector’s unique challenges in meeting U.S. seniors’ growing long term and post-acute care needs. In the midst of economic tumult and sector instability resulting from more than three years of cumulative federal and state funding cutbacks…seniors’ care is left in jeopardy, and more facility jobs are sure to be lost. We now fear additional facilities will be driven right to, if not over, the edge of operational viability.”

In other words, seniors who rely on skilled nursing facilities—perhaps the most vulnerable of all those covered by Medicare and Medicaid—are at risk because many of the facilities that serve them may not be able to absorb all of these cuts.

Maybe what’s needed is an army of seniors in wheelchairs toting oxygen tanks to rally on Capitol Hill and start raising a little hell of their own.

Let me tell you, facing that kind of wrath is no fun!

Bob Gatty has covered governmental developments for the trade and business press for more than 30 years. He is founder and president of G-Net Strategic Communications, Sykesville, Md.

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