WASHINGTON, DC — Just a month ago, skilled nursing providers were instrumental in convincing House lawmakers to reconsider their standing on provider taxes, which help fund long-term care in 46 states.

As the Senate digs in on its own version of the “One Big, Beautiful Bill,” advocates find themselves right back in the same position, American Health Care Association’s Senior Vice President of Government Relations Michael Bassett said here Tuesday.

“There was all kinds of talk about, ‘We should cut this. We should cut that.’ We got very nervous,” recalled Bassett of a weeks-long process to craft Medicaid cuts in the House Committee on Energy and Commerce. “We had to start a massive education campaign in the House to let them know how vital [provider taxes] are to seniors and disabled patients.”

Eliminating those taxes, which was once on the table in the House, “would be game over — devastating,” Bassett said.

Instead, with advocacy and education, the House went from considering elimination of the provider tax device to reducing a cap from 6% to 4%, then to 5% — to eventually deciding just to freeze the taxes at their current 6% max.

“It just goes to show, when we speak with one voice, the impact we can have,” Bassett told AHCA members gathered for day two of the association’s annual Congressional Briefing.

The House passed its version of the reconciliation bill on May 22 and Senate negotiations are ongoing, with behind-the-scenes jockeying heating up on key healthcare provisions — including a possible hit to Medicare Advantage spending. But the Senate will have to address some of the same considerations the House did, including whether to limit provider taxes, which could again come under fire.

“They’re going to make changes, and we find ourselves in the same type of environment,” Bassett said, noting options bandied about are to cut the max rate to 3% or altogether. “The effort we did in the House is now what we need to replicate in the Senate.”

Two-thirds of nursing home residents rely on Medicaid, and a cut to provider taxes would almost certainly impact home- and community-based services and assisted living waiver programs too.

Bassett said those are important reminders for Republican Senators who may be struggling with Medicaid cuts, especially if they affect politically sensitive seniors.

“The line that they’re saying is, ‘We just want to make able-bodied people work if they can, and we want to root out fraud, waste and abuse. We want to protect the full program for the people it’s intended for.’ Well, that’s us,” said Bassett, delivering a potentially powerful talking point as members prepared to head to the Hill at midday.

Members also got some advice from Sen. Mark Warner (D-VA), who is already planning to vote against the Trump-backed bill, which he said would be a “dramatic step back” for the Medicaid program.

He took Bassett’s talking points a step further, insisting that providers ought to make the case that access to care will become more limited without robust federal support for Medicaid.

“If they [patients] lose coverage, where do they go?” he asked. “Your group doesn’t operate on big margins. What is going to happen if you don’t have that Medicaid population?”

“Make that case for the many, many senior Americans that you take care of,” he added later. “Especially coming out of COVID, you don’t need another massive disruption.”

Warner’s comments amplified those of Health Care Association of NJ President and CEO Andrew Aronson, who told McKnight’s Long-Term Care News Monday that a similar scaling back of retroactive Medicaid coverage could reduce seniors’ access to nursing homes, and end up costing the government more as those residents are backlogged in hospitals.

New Jersey is actually underutilizing its approved provider tax rate, docking nursing homes only about 2.5%, when the state’s agreement with the Centers for Medicare & Medicaid Services allows a tax of up to the full 6%. Taxes collected go into a state’s Medicaid coffers and then can be redistributed to a  range of healthcare providers, which allows the state to earn more federal matching Medicaid dollars.

New Jersey is in the middle of its budget cycle, and Aronson said he is hoping to convince state leaders to expand their use of provider taxes to help bolster spending on senior care there.

For his part, Warner said he recognizes that many states use the additional funds to target staffing and other frontline investments. While he said he might be open to a longer-term conversation about how provider taxes are used and some gradual reform, but not “an abrupt cut-off, or the ability in this big bill to dramatically limit states’ ability to have that flexibility.”