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By Jim O’Neill
Deputy Secretary at the U.S. Department of Health and Human Services
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By stopping the Biden administration’s regulatory overreach of nursing homes before it takes effect, the Working Families Tax Cut Act delivers on President Donald Trump’s promise to strengthen Medicaid for those who need it most.
Under the Biden administration, nursing homes across America—particularly those serving rural, tribal and other underserved populations—faced an engineered crisis of scarcity. A rule finalized in 2024 by the Biden administration mandated minimum staffing standards for long-term care facilities that were simply unattainable by small, rural communities. This rule imposed rigid, one-size-fits-all requirements on every facility in the country without regard for the local labor supply, patient population, available resources, or the need for such requirements to protect patient safety.
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The mandate ignored local communities’ input and the needs of small businesses and further concentrated power in the hands of career regulators in Washington, D.C. Herein lies one of the dangers of overregulation: Even the most well-meaning and competent officials in Washington lack intimate knowledge of the locally variable minutiae—how many caretakers are available, client-side demand for care and other relevant data—required to determine how many staff members a nursing home must employ to be safe and high-quality. The answer changes depending on many factors, including locality.
Facts on the ground prove as much: in many parts of the country—but particularly in rural regions—care facilities lack the requisite number of nurses and aides to comply with the Biden mandate. In advance of the rule, the American Health Care Association published an analysis finding that the Biden mandate would require nursing homes across the country to hire “an estimated 102,154 additional full-time employees,” including 80,077 nurse aides and 22,077 registered nurses. After the rule was finalized, NPR reported that, by the Biden administration’s own prediction, four out of every five nursing homes nationwide would be unable to meet the new standards. Biden’s CMS estimated the cost but did not propose a funding source; the funds, NPR acknowledged, “would have to come out of owners’ pockets or existing facility budgets.” A study funded by the Biden administration estimated that the mandate could cost nursing homes between $7 billion and $10 billion each year.
Facilities in rural and tribal communities—which already struggle to recruit and retain qualified staff—often serve Medicaid patients with the narrowest financial margins. Instead of improving these patients’ care, the Biden mandate would put these facilities at the greatest risk of closure, potentially suspending health care access to the very communities it purported to serve.
The Trump administration understands that the preferred way to provide care is to empower communities to make decisions that suit them best. This is not a new idea. The Framers of our Constitution envisioned a nimble, energetic executive branch with powers that James Madison referred to in Federalist No. 54 as “few and defined.” Other powers were reserved to the states and the people.
In addition to betraying the spirit of America’s founding, the Biden mandate invited bipartisan, bicameral opposition. In December 2023, a coalition of Republican, Democrat and Independent senators introduced a bill to prevent Biden’s CMS from finalizing its April 2024 rule. The bill’s House companion also drew Democrat co-sponsorship. While ultimately denied passage, these bills showed the broad desire for a change of course. President Trump’s Working Families Tax Cut Act codified this desire of the American people into public law by stopping the mandate before it could take effect.
Under the leadership of Health and Human Services Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, this crippling Biden-era requirement has been stopped in its tracks, repealed effective today.
Thanks to the Working Families Tax Cut Act, long-term care facilities can continue to serve patients in accordance with existing state and federal quality standards based on clinical need, workforce supply and other realities that local authorities and caretakers will always have better firsthand knowledge of than D.C. regulators. By rejecting bureaucratic overreach and embracing local sovereignty, President Donald Trump’s Working Families Tax Cut Act delivers another tangible victory for rural Americans, ensuring that nursing homes can keep their doors open and safeguarding essential health care services for those who need them most.
Jim O’Neill is the deputy secretary at the U.S. Department of Health and Human Services.
The views expressed in this article are the writer's own.
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