Übersicht
The nursing home and long-term care industry is a billion-dollar business in the United States. Most facilities are privately owned, but licensing laws, federal and state regulations, and health care policy legislation impact the entire industry.1 Perhaps that is why the industry is a perennial and generous contributor to current and potential state lawmakers.
Figure 1: Contributions From Nursing Home and Long-Term Care Industry, by State, 2001–2016
From 2001 through 2016, nursing home and long-term care industry political donors contributed $104.9 million to state-level candidates and party committees in every election cycle and in every state except Wyoming. Industry giving in Illinois significantly outpaced all other states: the industry’s largest total contributions came from Illinois donors, and Illinois candidates were the top recipients of the industry’s largesse in every election cycle since 2007.
Compared to other types of businesses, contributions from nursing home and long-term care providers, their associations, owners, and employees are impressive, ranking 42nd among 410 business interests identified by the National Institute on Money in State Politics.
Even more impressive is the unmistakable connection between the industry’s contribution practices from 2009 through 2012, and the heated debates2 over the Affordable Care Act (ACA)3 and Medicaid expansion that resulted in policies with a significant and lasting impact on nursing homes and long-term care providers.
The Institute analyzed 16 years of that industry’s donating behavior and grouped the data into four-year periods. Contributions given in 2009–2012—during the ACA/Medicaid debates—stood out:
- Contributions increased by 37 percent.
- Contributions in 20 states reached their highest levels.
- More than half of the industry money came from just 38 contributors.
- Health Care Council of Illinois (HCCI) outpaced every other contributor, more than doubling the amount given by the next-highest contributor.
Figure 2: Contributions From Nursing Home and Long-Term Care Industry, by Four-Year Election Periods, 2001–2016
Top Donors
Just 38 of the 6,400-plus industry donors accounted for more than half of the money given during the debates and implementation of the ACA and Medicaid expansion. All 38 contributed between $500,000 and $8.4 million. Of the 38 donors, 33 contributed in every four-year election cycle, and 14 of the 38 contributed at their highest level during that four-year period. With few exceptions, and apart from the national organizations, most donors focused their giving on recipients in their home state.
Figure 3: Contributions From Top 38 Nursing Home & Long-Term Care Providers, by Four-Year Election Periods, 2001–2016
The top contributor, Health Care Council of Illinois (HCCI),4 gave to Illinois candidates and party committees exclusively, far surpassing all other contributors by giving twice the amount of the next-largest contributor.
HCCI gave $6.6 million to Illinois gubernatorial and legislative candidates who, if successful, would become the policymakers who could directly affect the nursing home industry. $1.2 million went to four key legislative policymakers: the senate president, the house speaker, the former house minority leader, and the current senate minority leader. Half of the $1.2 million was given during the ACA/Medicaid debate.
A Closer Look at Illinois
Illinois candidates and party committees were the top recipients of contributions from nursing homes and long-term care providers. A number of issues in Illinois received the attention of the industry—from the passage of the nursing home safety laws in 20105 to Medicaid expansion in 2013,6 to a campaign squabble between Democratic Gov. Pat Quinn and his 2014 Republican challenger, Bruce Rauner, wherein Quinn took aim at Rauner over questionable patient treatment in nursing homes Rauner was invested in.7 On July 22, 2013, Gov. Quinn, an advocate of Medicaid expansion, signed Senate Bill 26 (the Medicaid-Health Benefits Service bill, making Medicaid coverage available to all low-income adults in Illinois).8 Gov. Quinn’s 2010 election garnered $379,617 from the industry and another $348,780 during his unsuccessful reelection campaign in 2014. In comparison, Rauner, who was largely self-funded, received just $44,466 from the industry during the 2014 campaign.
Other key Illinois policymakers who made decisions impacting the industry were also well supported. Of the $10 million given to legislative candidates since 2001, $2.2 million went to legislative leadership; and of the $3.4 million contributed to legislative candidates from 2009 through 2012, $915,271 went to four legislative leaders. The four leaders targeted were:
- The longest serving speaker of the Illinois House of Representatives, Democratic Rep. Michael Madigan, received $1.1 million from the industry, with $288,439 of it given from 2009 through 2012. Rep. Madigan voted for Senate Bill 26.9
- Democratic Sen. John J. Cullerton, who has served in the Illinois legislature since 1979 and as senate president since 2009, was a co-sponsor of Senate Bill 26. The industry has given Cullerton $381,932 in total, the largest share of it ($257,832) given during his successful 2012 campaign.
- Former Republican house minority leader Tom Cross, and former senate minority leader, Christine Radogno, received $309,250 and $429,100, respectively. Despite the fact that the industry’s contributions to Cross and Radogno totaled $200,500 and $168,500 from 2009 through 2012, both Cross and Radogno voted against Senate Bill 26.10 11
National Associations and Affiliate Giving
From 2001 through 2016, affiliates associated with one or more of three national associations—the American Health Care Association (AHCA), the National Center for Assisted Living (NCAL), and Argentum, formerly known as the Assisted Living Federation of America (ALFA)—were active contributors, but their overall contributions reached an all-time high from 2009 through 2012.
Figure 4: Contributions From Nursing Home and Long-Term Care National Associations, by Four-Year Election Periods, 2001–2016
Of the $39.8 million given by the three associations and their affiliates, the lion’s share ($37.8 million) came from AHCA, which contributed in every election cycle between 2001 and 2016. AHCA gave its largest four-year total ($11.4 million) during the ACA/Medicaid expansion debate.
An affiliate of all three associations and the second-largest contributor overall, the Oregon Health Care Association (OHCA) / Oregon Center for Assisted Living was an active contributor to Oregon candidates and party committees exclusively. OHCA gave $4 million from 2001 through 2016, but gave its largest four-year total ($1.4 million) during the health care debates. There was no legislative action regarding Medicaid expansion issues in Oregon, per se, but due to the ACA, eligibility was extended to more people in 2014.12 Health coverage for low-income Oregonians has been in existence since 199413 through the health insurance exchange, Oregon Health Plan.
An AHCA and NCAL affiliate, the Florida Health Care Association gave in every cycle, landing it the number three spot with overall contributions of $3.1 million. The association overwhelmingly favored Florida political party committees with $2.4 million—nearly half of it given to Florida party committees ($1.3 million) during the ACA/Medicaid expansion debates.
Florida’s Republican-controlled state senate approved a Medicaid expansion bill in April 2015 that was defeated by the Republican-run state house. Republican Governor Rick Scott, who has changed his mind more than once about Medicaid expansion,14 received $6,000 in 2014 from the association. In 2010, Scott received $11,000 from 18 industry donors—none of which were affiliated with a national association. He went on to win the open seat.
Another AHCA and NCAL affiliate, Iowa Health Care Association / Iowa Center for Assisted Living, gave a combined $120,089 to former Iowa Republican Gov. Terry E. Branstad’s successful campaigns in 2010 and 2014. The Branstad administration agreed to Medicaid expansion in 2013 using an alternative plan.15
NCAL did not contribute as a national association, but its affiliate, Alaska State Hospital and Nursing Home Association, gave $32,250 from 2009 through 2012. A combined $24,750 of that went to 28 successful Alaskan legislative candidates. In July 2015, Alaska’s Independent Governor Bill Walker made Medicaid expansion a reality in Alaska in spite of facing a battle with the legislature.16 The legislature asked the state supreme court to intervene but the court ruled against it.17 In 2014, Walker and his running mate, Byron Mallott, received $1,000 from Alaska State Hospital and Nursing Home Association.
Contributions to Gubernatorial and Legislative Candidates
From 2001 through 2016, 93 cents of every dollar the industry contributed to state-level campaigns went to candidates running for governor or the legislature—those who could have the greatest impact on state policies affecting nursing homes and long-term care providers.
During the ACA/Medicaid discussions, candidates running for the governor’s mansions in 48 states received $6 million from this industry that hedged its bets by giving just 5 percent ($328,031) to challengers. The industry’s investments paid off—more than half of the $6 million went to winners, with most of that ($2.1million) going to successful incumbents.
Figure 5: Nursing Home & Long-Term Care Industry Contributions to Gubernatorial Candidates, 2001–2016
Georgia’s Republican Gov. Nathan Deal had not agreed to Medicaid expansion, and many of Georgia’s leaders, including Gov. Deal, were firmly against it.18 Despite his opposition, the governor received $189,600 from the industry during his successful win of the open seat in 2010. Among gubernatorial candidates overall, Deal was the seventh-highest recipient of industry donations at $417,400.
Incumbent legislators fared well during the 2009–2012 cycle, with 80 percent of $17.5 million going to their candidacies. The industry’s ability to select legislative winners was just as impressive—$8 of every $10 went to successful candidates.
Figure 6: Nursing Home and Long-Term Care Industry Contributions to Legislative Candidates, 2001–2016
Fazit
The Institute’s analysis of contributions from nursing home and long-term care providers in 16 state-level elections—many of which took place concurrent with health care and budget policy battles in Washington, D.C., and in state capitals across the nation—suggests the industry’s attention or generosity will continue.
The industry increased its already impressive financial participation during the ACA and Medicaid expansion discussions when the early debate over those national health care reforms monopolized the news. Concurrently, a related debate heated up in many states facing major budget crises.
The election of state policymakers is likely to remain on the industry’s financial radar for some time. First, the latest failed Congressional attempt to repeal the Affordable Care Act19 is probably not the last word on repeal. Second, President Trump’s proposed 2018 budget calls for deep cuts to Medicaid.20 These budget decisions and attempts to deal with the problems surrounding the ACA will most certainly add to the struggles state policymakers face when trying to balance budgets, and the proposed Medicaid cuts will continue to draw attention from nursing home and long-term care providers because the impact on their industry could be great. Contributions from this industry will probably remain high as key issues surrounding these two contentious laws continue to grab headlines.
- 1. “Nursing Homes & Long-Term Care Facilities Industry Profile,” Dun & Bradstreet First Research, available from http://www.firstresearch.com/Industry-Research/Nursing-Homes-and-Long-Term-Care-Facilities.html, accessed Novembr 7, 2017.
- 2. On March 23, 2010, when the ACA became the law of the land, states were required to comply with the expansion of their Medicaid programs. If states opted out of expansion they risked losing federal funding for Medicaid coverage. But in June of 2012, the U.S. Supreme Court agreed that Congress, by way of the ACA, could not force states into agreeing with the expansion by threatening to withhold federal money. As of November 2017, Medicaid expansion had been approved in 32 states. Faced with expiration of federal aid for Medicaid, state policymakers—governors and legislatures—were forced to make difficult decisions that directly affected the nursing home and long-term care industry because Medicaid is a prime source of funding for nursing homes and long-term care facilities.
- 3. Patient Protection and Affordable Care Act, Healthcare.gov, available from https://www.healthcare.gov/glossary/patient–protection–and–affordable–care–act/, accessed April 18, 2017.
- 4. “HCCI serves as the joint government affairs and communication arm for the Illinois Health Care Association and the Illinois Council on Long Term Care,” Illinois Council on Long Term Care, May 18, 2009, available from http://www.nursinghome.org/pro/popups/releases/news05_18_09.html, accessed July 31, 2017.
- 5. Jackson, David & Gary Marx, “ Quinn signs new nursing home safety bill,” Chicago Tribune, July 29, 2010, available from http://articles.chicagotribune.com/2010-07-29/health/ct-met-nursing-home-bill-signing-20100729_1_nursing-home-steans-nursing-staff-levels, accessed July 26, 2017.
- 6. Frost, Peter, “Quinn signs Illinois Medicaid expansion bill,” Chicago Tribune, July 22, 2013, available from http://articles.chicagotribune.com/2013–07–22/business/chi–illinois–Medicaid–expansion–20130722_1_Medicaid–expansion–Medicaid–coverage–lincoln–health, accessed April 25, 2017.
- 7. Carlson, Erin, “Quinn Knocks Rauner Over Nursing Home Controversy,” NBC 5 Chicago, May 8, 2014, available from http://www.nbcchicago.com/blogs/ward-room/Governor-Quinn-Rauner-Nursing-Home-Controversy-Illinois-Elections-258481231.html, accessed July 26, 2017.
- 8. Frost, Peter, “Quinn signs Illinois Medicaid expansion bill,” Chicago Tribune, July 22, 2013, available from http://articles.chicagotribune.com/2013–07–22/business/chi–illinois–Medicaid–expansion–20130722_1_Medicaid–expansion–Medicaid–coverage–lincoln–health, accessed April 25, 2017.
- 9. Michael Madigan’s Voting Record, Project Vote Smart, available from http://votesmart.org/candidate/key–votes/6356/michael–madigan/?p=2#.VmslUWSrRs8, accessed September 12, 2017.
- 10. Tom Cross’s Voting Record, Project Vote Smart, available from https://votesmart.org/candidate/key–votes/6312/tom–cross#.VmskhWSrRs8, accessed September 12, 2017.
- 11. Christine Radogno’s Voting Record, Project Vote Smart, available from https://votesmart.org/candidate/key-votes/9515/christine-radogno/?p=2, accessed September 12, 2017.
- 12. Budnick, Nick, “Oregon cuts tally of people lacking health insurance by 10 percent in two weeks,” The Oregonian, October 17, 2013, available from http://www.oregonlive.com/health/index.ssf/2013/10/oregon_has_cut_tally_of_those.html, accessed August 17, 2017.
- 13. Oberlander, Jonathan & Marmor, Theodore & Jacobs, Lawrence, “Rationing medical care: rhetoric and reality in the Oregon Health Plan, CMAJ.JAMC, May 29, 2001, available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC81116/, accessed November 14, 2017.
- 14. Millman, Jason, “Florida’s Republican governor says he no longer supports expanding Medicaid,” Washington Post, April 6, 2015, available from https://www.washingtonpost.com/news/wonk/wp/2015/04/06/floridas-republican-governor-just-flip-flopped-on-the-medicaid-expansion/?utm_term=.55ac8b172e1c, accessed August 17, 2017.
- 15. Masters, Clay, “Iowa Opens The Doors To Medicaid Coverage, On Its Own Terms,” NPR, December 26, 2013, available from http://www.npr.org/sections/health–shots/2013/12/26/257374213/iowa–opens–the–doors–to–Medicaid–coverage–on–its–own–terms, accessed April 25, 2017.
- 16. Goodnough, Abby, “Over Objections of Legislature, Alaska’s Governor Says He Will Expand Medicaid,” The New York TImes, July 16, 2015, available from http://www.nytimes.com/2015/07/17/us/over–objections–of–legislature–alaska–governor–bill–walker–says–he–will–expand–Medicaid.html?_r=0, accessed April 25, 2017.
- 17. Hanlon, Tegan, “Alaska Supreme Court allows Medicaid expansion to take effect Tuesday,” Alaska Dispatch News, August 31, 2015 updated September 28, 2016, available from https://www.adn.com/politics/article/xg/2015/08/31/, accessed July 19, 2017.
- 18. Miller, Andy, “Feds make pitch for Ga. Medicaid expansion,” The Augusta Chronicle, June 8, 2015, available from http://chronicle.augusta.com/news/government/2015–06–08/feds–make–pitch–ga–Medicaid–expansion, accessed April 25, 2017.
- 19. Phillips, Amber, “Republicans’ latest last-ditch attempt to repeal Obamacare is another legislative mess,” Washington Post, September 25, 2017, available from https://www.washingtonpost.com/news/the-fix/wp/2017/09/25/republicans-latest-attempt-to-repeal-obamacare-is-another-legislative-and-political-mess/?utm_term=.e44bde5d6c16, accessed November 14, 2017.
- 20. Lee, MJ and Luhby, Tami, “Trump Budget: $800 Billion in Medicaid Cuts,” CNN, May 24, 2017, available from http://www.cnn.com/2017/05/22/politics/Medicaid–budget–cuts/, accessed November 13, 2017.
Clearly, you're interested in following the money.
It costs more than $2 million a year to provide these verifiable facts about money in politics.
Do you know we simply give it to you, 24 hours a day, 365 days a year.
How often does that happen elsewhere in your life?
Please donate. You'll help us keep democracy transparent!