Pushback on Trump Initiatives

by Kristin Rowan | May 23, 2025 | Regulatory

by Kristin Rowan, Editor

Pushback on Trump Initiatives From All Sides

Pushback on Trump initiatives, including the steep cuts to Medicare, Medicaid, Social Security, and VA benefits erupted this week. Coalitions, associations, and members of Congress seek to stop the cuts before the new bill is passed. The Republican-backed bill, under direction from President Trump, called the “Big, Beautiful Bill” would cut federal spending by billions of dollars over ten years. Pushback on Trump’s executive orders is also making headway, with temporary and preliminary injunctions.

Protect Our Healthcare Coalition

Protect Our Healthcare Coalition is a group of consumer and non-profit organizations in Rhode Island. This week, they joined with Medicaid members and Senators Reed and Whitehouse to speak out against the Medicaid cuts in the bill. The coalition also released a report on the impact of Medicaid services in the state.

“Republicans…want to whack Medicaid so fewer people have coverage and costs go up. These cuts will do real harm, pushing seniors out of nursing homes, increasing hospital closures, and denying families access to preventative care. If you think the emergency room is crowded now, just wait until Trump’s Medicaid cuts happen.”

Jack Reed

Senator, (D) Rhode Island

Protecting Retirement and Health Benefits

Congresswoman Mikie Sherrill (NJ-11) introduced the Protecting Retirement and Health Benefits for Working Families Act. The bill is in response to the recent federal program and job cuts. The legislation requires that before any cuts are made to jobs or programs that the administration can prove those cuts won’t harm to benefits and those who rely on them. It also requires a study within one year of any mass layoffs or closures to ensure no harm was done.

Federal Judge Blocks...

DoE Layoffs

More than 1,300 employees of the Department of Education received notice of termination in March from then-Secretary of Education Linda McMahon. The layoffs reduced the staff by nearly half. McMahon initially said they were part of the plan to reorganize and streamline the department for efficiency and accountability. Trump later revealed the layoffs to be the first step in dismantling the Department of Education altogether. District Judge Myong Joun, a Biden appointee, said, “The record abundantly reveals that defendants’ true intention is to effectively dismantle the department without an authorizing statute.” Judge Joun issued an injunction blocking the mass layoff.

Sweeping Agency Changes

In February, the Trump administration issued an executive order, followed by a number of memos, instructing multiple federal agencies to cut staff. The executive order called for the immediate dismissal of temporary and reemployed annuitant staff members. Specifically, it called out those performing functions not mandated by statute or other law, not designated as essential, or is not suited to federal service due to failure to comply with federal employment requirements. The order also reduced hiring ratios to 1:4, permitting agencies not under a hiring freeze to hire one person for every four that leave.

U.S. District Judge Susan Illston, in San Francisco, as part of a lawsuit filed by labor unions, nonprofits, and local governments, issued a temporary block on the overhaul. The lawsuit alleges that Trump needs authorization from Congress to restructure the federal government. Judge Illston says the office of the president can seek changes to agencies, but only through Congress. Illston also issued a temporary restraining order barring agencies from any further implementation of the executive order. This includes the final dismissal of employees who have received layoff notices that have not yet been executed. The temporary restraining order expires May 23, 2025. Additionally, Illston ordered the administration to submit restructuring plans to the court.

Revoking Student Status

The administration attempted end the legal status of international students. This would effectively nullify their right to stay in the United States. Some individual students challenged the action successfully. On May 22, 2025, a federal judge in California blocked the action. He prohibited the administration from arresting or detaining foreign-born students on the basis of their immigration status. The administration insists the immigration status was only revoked for students who had criminal charges.

Pushback on Trump Initiatives is Ongoing

Along with the passing of the “Big, Beautiful Bill,” these issues are ongoing and The Rowan Report will provide updates as they become available.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Medicare Advantage Increase for Payers, not Providers

by Kristin Rowan | Jan 23, 2025 | Artificial Intelligence, Breaking News, CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

CMS Announces Medicare Advantage Pay Hike

On January 13, 2025, CMS announced its plans to increase payments to Medicare Advantage plans by 4.33%. Policy changes for Medicare Advantage and Part D include changes in how the agency calculates payments to health plans. A spokesperson from CMS said that the policy change provides access to affordable, high-quality care. The changes, however, don’t increase payments to the people actually providing the care, only to the payers.

Opposition

While major health plans across the U.S. were thrilled with the announcement and saw substantial stock price hikes immediately after, not everyone is on board. The American Medical Association (AMA) outlined how physicians who treat Medicare patients are getting pay cuts from CMS for the fifth year in a row. Meanwhile, HHS OIG released a report finding that MA insurers profited $7.5 billion from risk-adjusted payments in 2023.

“It’s unbelievable they’re giving insurance companies that had record profits an increase while at the same time cutting payment to physician practices that are struggling to survive. This contrast highlights the urgent need for Congress to prioritize linking payment to physician practices to the cost of providing care.”

Bruce Scott, M.D.

President, American Medical Association

Out-of-Pocket Cost Increase

In addition to the higher payments, the advance proposal includes an increase in the Part D deductible from $590 to $615. With this proposal, the out-of-pocket maximum will increase from $2,000 to $2,100 as well. Cost sharing after the deductible is reached but before the out-of-pocket max is reached will also increase. There is no increase for beneficiaries whose income is less than 100% of the Federal Poverty Level.

Coverage Increase

The CMS advance proposal calls for coverage and policy changes. Medicare and Medicaid programs will now cover anti-obesity medications. The plan imposes stricter rules on MA policies to prevent denial of reasonable and necessary services that would be covered under Medicare Part A and B. Finally, imposed guardrails on the use of AI. The guardrails will ensure AI systems are unbiased in patient care decisions. Additionally, the guardrails will ensure they do not perpetuate existing inequity in access to and receipt of medical services. The American Hospital Association appplauded this last change.

“The AHA commends CMS for taking important steps to increase oversight of 2026 Medicare Advantage plans to help ensure enrollees have equal access to medically necessary health care services. The AHA has previously raised concerns about the negative effects of certain Medicare Advantage practices and policies…that are more restrictive than Traditional Medicare and can compromise enrollee access to Medicare-covered services.”

Ashley Thompson

Senior Vice President, American Hospital Association

Changes are not Definite

Even though CMS has announced these changes to start in January, 2026, they are not set in stone. As of January 20, 2025, we are operating under anew administration and the changes under Trump have already started. CMS intends to continue it’s three-year plan to update the MA risk adjustment model and the implementation of the Inflation Reduction Act. However, it seems likely that the Inflation Reduction Act will be replaced with a different plan for inflation.

Jeff Davis, director of health policy at McDermott+ believes it is likely that Trump’s team will throw out the updates to MA and Part D as well as Biden’s proposed staffing mandate for SNFs. In the first 24 hours of his Presidency, Trump revoked both Biden’s “Strengthening Medicaid and the Affordable Care Act” and “Continuing to Strengthen Americans’ Access to Affordable, Quality Health Coverage” executive orders. He also rescinded the Drug Pricing Model executive order that covered obesity drugs, lowered the price of some drugs, and accelerated FDA approval for drugs that address unmet medical needs.

As Yet Unknown

As was to be expected, many of Trump’s initial 78 executive orders are already facing lawsuits from various entities. There are as of yet no definitive answers to changes in Medicare, Medicare Advantage, or other policies that impact healthcare and care at home. The Rowan Report will continue to follow these stories as they unfold.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

Medicare Advantage Stock Prices After Trump Elected

by Kristin Rowan | Nov 15, 2024 | Clinical

by Kristin Rowan, Editor

Will the Change in Leadership Usher in a Change in Reimbursement Rates?

As in any election year, we have been bombarded with promises, predictions, and pandering from senate and house hopefuls as well as presidential candidates from every party. Each of them found platform issues that resonated with their followers. In turn, they have accused their opponents of all manner of sin.

Now that the election has passed and the lame duck session of congress has begun, analysts have started looking to January and how election results may impact different industries. Analysts believe Trump, along with congressional Republicans, will aggressively push Medicare Advantage. One researcher predicts that traditional Medicare will “wither on the vine.”

Privatization

Opposition to our current health care and insurance system often advocate for a single-payer system that is seen in places like England and Canada. Naysayers refer to this as the “socialization” of medicine, referring to socialist and communist governments. Privatization, on the other hand, moves healthcare out of the hands of the government and into the hands of privately held, usually for-profit, health insurance companies. Medicare Advantage has quietly moved more than 50% of all Medicare eligible patients to a privatized system. Senior policy analyst at Paragon Health Institute, Joe Alabanese believes that the Trump administration and a republican Congress would be “more friendly” to the idea of privatized health care.

Insurer Stock Prices

Whether the stock prices just before and after election day are predictive of things to come remains to be seen. For now, the information before us is this:

- Between Nov 1 and Nov 7, Humana Inc. had the largest increase in stock prices at 10.7%
- UnitedHealth Group Inc. rose 5.1% in the same time period
- Both companies had greater stock increases than the average across S&P
- Elevance Health was in keeping with the rest of the S&P with an increase of 3.6%
- Molina Healthcare, Inc. and The Cigna Group dropped 0.2% and 0.4%, respectively

Analysts say the jumps are in keeping with expectations that Republican control in Congress and in the White House will be beneficial for Medicare Advantage

Final Thoughts

It’s no secret that The Rowan Report is not a fan of Medicare Advantage. Specifically, the sales tactics used on the elderly and infirmed are predatory and the denial rate is criminal. The more eligible patients sign up for Medicare Advantage the less they will receive the care they need. Further, the more Medicaid has to supplement the cost of Medicare Advantage, the more home care agencies will suffer. Nationally, the more CMS regulates payment rates, pre-authorizations, and denial rates by privatizing Medicaid, the worse off our entire healthcare system will be.

With the state and national associations, we will continue to advocate on behalf of care at home agencies and their patients. And we hope you will too, regardless of who is in office. We have support at the federal level and we will continue to fight the good fight.

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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Home Health and Hospice Face Another Election Year

by Tim Rowan | Sep 20, 2024 | Editorial

by Tim Rowan, Editor Emeritus

Home Health Hospice and the Election

It happens every four years. Once the Olympic torch has been extinguished, Americans turn their attention from athletics to politics, specifically to choosing their next President. While watching the Harris/Trump debate this week, my thoughts turned to the dilemma faced by Home Health, Hospice, and Home Care owners, managers, and field staff.

U.S. voters can make their voting decision after taking into consideration the policy proposals of each candidate and analyzing which policies might better benefit themselves or their businesses. Voters can also vote along party lines, regardless of the candidate or their policies. And then, there is always a percentage who set their personal advantages aside and vote for the candidate they believe to be better for the nation as a whole.

Choice 2024

This may be where our healthcare sector finds itself this year. Is what is best for the country also best for Home Health, Hospice, Palliative Care, and Home Care? Or might the needs of one diverge from the needs of the other? If the latter, which choice is the higher calling?

In this week’s debate, the broad healthcare issue merited little more than a mention and some vague promises. Post-acute care was apparently unimportant or unknown to both candidates. Had a clever writer been tasked with summarizing that moment, it might have read, “Unhealthy Healthcare Debate Fails to Heal.” What did we learn, and where does it leave us?

Balancing Your Responsibilities

Voters have twin responsibilities, each as simple as it is profound. First, to decide whether to base their choice on party alone, on personal or business gain, or for the benefit of all. This includes whether the same vote will accomplish both or whether it is necessary to pick one or the other. The second responsibility is to research the issues and each candidate’s position on each issue. An informed voter is a patriotic voter.

Taylor Knows Best?

Once a voter has committed to the basis for their choice, the second responsibility is met by reading. Oddly, this retired grandfather cannot express that idea any better than a 34-year-old pop singer. In her September 10 endorsement statement, Taylor Swift said:

“Now is a great time to do your research on the issues at hand and the stances these candidates take on the topics that matter to you the most. As a voter, I make sure to watch and read everything I can about their proposed policies and plans for this country. I’ve done my research, and I’ve made my choice. Your research is all yours to do, and the choice is yours to make.”

History May Repeat Itself

Home Health and Hospice are deeply dependent on government spending. In the immediate future, MedPAC and CMS can be counted upon to continue to squeeze profit margins as they shift their gaze from services to outcomes. For more than two decades, CMS has enacted rules that shrink the total number of Home Health agencies. This happened across four administrations with different political ideologies. The result is agencies serving the same number of beneficiaries with the same number of nurses while supporting fewer executives.

The meeting of self-interest and national interest may be stronger in the Home Care sector. Caregiver shortage pushes higher hourly pay rates, which pushes higher hourly fees, which decreases the number of clients willing and able to pay. An economy that creates more spendable income or savings means the threshold between “can’t afford it” and “we’ll make it work” lowers.

No, This is not an Endorsement

I guess the bottom line is that I agree with the young pop singer. Like her, I have done my research and made my decision. I urge you to do the same. Read everything you can from the source, if you can. Avoid the temptation to rely on anyone else’s summaries of candidate positions and plans. Think “patriotism” first and “what’s in it for me” second. When in doubt, revisit the words of speechwriter Ted Sorensen, whose brilliant poetry was etched permanently into American history through the voice of John F. Kennedy. “And so, my fellow Americans, ask not what your country can do for you; ask what you can do for your country.”

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Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com