Why It Matters
The American Health Care Association is fighting for the financial survival of America’s nursing homes amid a perfect storm of crises. The sector faces nearly $1 trillion in Medicaid cuts over 10 years, immigration crackdowns decimating a workforce that provides roughly 30-40% of caregiving labor, and the first major bankruptcy already filed by Genesis Healthcare.
With Medicaid covering two-thirds of nursing home residents, the proposed cuts could be catastrophic—the last time such cuts happened in 1997, five of the seven largest operators went bankrupt by 2000. AHCA’s lobbying strategy reflects this desperation: securing immigration reform, blocking Medicaid reductions, and promoting workforce development initiatives.
By the Numbers
The American Health Care Association reported $860,000 in Q3 2025 lobbying expenditures. Since 2003, AHCA has filed 77 lobbying disclosures totaling $58.7 million.
The Q3 team includes Michael B. Bassett, former Staff Director for the Senate Special Committee on Aging, and Dana Halvorson Ritchie, who worked as Senior Adviser for Health Policy on the Senate Budget Committee.
AHCA supplements its in-house team with external firms including Capitol Counsel LLC ($4.4 million since 2011) and BGR Government Affairs LLC ($7.5 million since 2013).
The Agenda
AHCA is lobbying on six major areas: labor standards (opposing minimum staffing mandates while promoting workforce development bills like the Train More Nurses Act), immigration (streamlined pathways for international caregivers), Medicare and Medicaid policy (opposing cuts and addressing payment rules), veterans affairs (VA Provider Agreements), health issues (telehealth reforms), and housing initiatives including the Expanding Service Coordinators Act of 2025 (H.R. 5057).
Broader Context
AHCA’s lobbying surge occurs amid existential threats. While CMS is moving to rescind the federal nursing home staffing mandate, the industry faces graver pressures. Genesis Healthcare filed Chapter 11 bankruptcy, with 135 nursing homes filing bankruptcy since 2020.
The workforce crisis compounds financial headwinds. More than 41% of home health aides and 30% of nursing home staff are foreign-born, but immigration enforcement is forcing facilities to fire workers. One Florida CEO estimated needing $600,000 annually to compensate for immigrant worker departures.
Between The Lines
Congress is intensifying scrutiny. The House Ways and Means Health Subcommittee held hearings warning about Medicaid cuts. Republicans introduced the Protecting Rural Seniors’ Access to Care Act to block staffing standards.
Bipartisan momentum exists on workforce development. Reps. Nunn, Titus, and Lee introduced the Train More Nurses Act, addressing staffing shortages. Veterans’ care remains a focus, with House Veterans’ Affairs hearings revealing VA per diem payments cover less than 30% of actual care costs.
Competitive Landscape
LeadingAge Inc., representing non-profit aging services providers, lobbies on identical issues. Both organizations successfully challenged staffing rules in court, with a Texas federal judge striking down key provisions.
The industry faces coordinated threats: Medicaid cuts, immigration enforcement reducing the workforce, and potential Medicare sequestration cuts. This convergence explains coordinated lobbying efforts across the sector.
The Bottom Line
With Medicaid cuts threatening facilities’ primary revenue source and workforce shortages intensifying, the industry’s advocacy isn’t about policy preferences—it’s about operational survival. Without legislative intervention on immigration and Medicaid funding, the sector risks mass closures and care disruptions for millions of seniors.
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