Why It Matters
The nursing home industry faces a financial crisis. Federal Medicaid cuts signed into law in July 2025 threaten to force over 1,600 facilities to close nationwide, with more than half of nursing homes planning to cut staff under the new reductions. While AHCA has successfully blocked the federal staffing mandate through courts and Congress—achieving a nine-year implementation delay and triggering a potential administrative repeal—the industry now confronts a more immediate threat: state-level workforce standards boards mandating wage increases and staffing ratios, coupled with Democratic scrutiny of industry practices.
By the Numbers
AHCA’s $90,000 quarterly investment in theGROUP DC LLC reflects a strategic pivot to navigating these dual pressures. By deploying lobbyists with deep connections to Democratic leadership—including Darrel L. Thompson, a former senior advisor to Senate Majority Leader Harry Reid, and Joseph Kwabena Nsiah, a former deputy chief of staff to House Democrats—AHCA is attempting to influence negotiations over Medicaid reimbursement rates and workforce policy before state-level action becomes the dominant regulatory landscape.
AHCA maintains a sprawling lobbying operation, having filed 77 in-house disclosures totaling $58.7 million in expenditures since 2003. The organization employs multiple specialized firms including BGR Government Affairs LLC ($7.5 million over 51 filings since 2013) and Capitol Counsel LLC ($4.4 million over 57 filings since 2011).
theGROUP DC LLC itself has received $1.7 million across 21 disclosures since AHCA retained the firm in 2021.
The Agenda
AHCA is lobbying to block or modify a federal minimum staffing mandate for nursing homes. The industry group is pushing for alternative solutions, including the Protecting Rural Seniors’ Access to Care Act, which would block the staffing rule and create an advisory panel instead. AHCA also supports bills like the Certified Nursing Assistant Workforce Improvement Act and the I CAN Act to expand the worker pipeline without imposing federal requirements.
AHCA’s deployment of lobbyists with deep Democratic connections signals the group is pursuing a bipartisan strategy, not simply relying on Republican allies as the staffing mandate combined with proposed Medicaid cuts threatens facility viability.
Broader Context
A federal court struck down key provisions of the Biden administration’s staffing mandate in April 2025, and Congress delayed implementation until 2035, representing major wins for AHCA. However, new threats have emerged. Federal Medicaid cuts signed into law in July 2025 directly threaten nursing home finances since Medicaid covers the majority of residents nationally.
State-level action presents fresh obstacles. Minnesota’s Nursing Home Workforce Standards Board has mandated wage floors ranging from $19-$28.50 per hour, with nursing home operators warning of facility closures. Meanwhile, Democratic senators including Elizabeth Warren and Ron Wyden are probing UnitedHealth’s nursing home practices, signaling intensified regulatory scrutiny.
Between The Lines
Republicans have introduced legislation to block the rule entirely with the Protecting Rural Seniors’ Access to Care Act and its House companion. Democrats are countering with alternative workforce bills like the Certified Nursing Assistant Workforce Improvement Act that expand training rather than impose mandates.
Recent House Ways and Means and Senate Finance Committee hearings have become proxy battles over the rule’s merits. Rep. Michelle Fischbach (R-MN-7) vowed to overturn the mandate as a "half-baked, one-size-fits-none plan." Meanwhile, Rep. Lloyd Doggett (D-TX-37) framed Republican efforts as trying to "take the nurses out of nursing homes."
Competitive Landscape
The nursing home staffing mandate has sparked industry-wide mobilization beyond AHCA. Sanford Health/Good Samaritan and LeadingAge Inc. are actively lobbying on identical staffing rule issues, with filings highlighting immigration reform needs. These organizations share a unified message: the staffing mandate is unworkable due to workforce shortages, and Congress must pursue alternative solutions like immigration reform and training flexibility.
The Bottom Line
AHCA’s continued investment in high-level lobbying indicates ongoing concern about regulatory reversals and the need to protect both against stricter federal standards and cuts to the Medicaid funding that covers the majority of nursing home residents. The engagement reflects an industry under simultaneous pressure from federal mandate delays, Medicaid cuts threatening facility viability, and state-level workforce standards boards imposing new requirements.
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