Political volatility and a sense of managed chaos have become defining features of the environment shaping the senior housing industry. This theme, underscored throughout Brian Perry's recent remarks at the NIC annual conference, reflects a sector forced by design and circumstance to adapt, advocate and anticipate. Perry, vice president of government affairs at Direct Supply, does not attempt to sugarcoat the fractious terrain. Instead, he urges industry stakeholders to recognize that operating amidst political chaos is not just situational—it is now a strategic constant facing senior care providers, investors and policymakers alike.
Perry set the tone early, reminding his audience that regardless of political affiliation, the fundamental challenge remains unchanged: support a system that is “pro senior” from nine to five. In a world where congressional control can shift with a single vote and legislative success is precariously rare, he noted, "there is just no margin for error when it comes to trying to pass legislation in this country." Against this backdrop, the mood in Washington, D.C., and across the capital markets supporting senior care is one of heightened uncertainty and urgency. A relentless news cycle—where a local facility’s misfortune can make national headlines in minutes—only compounds the feeling that the ground is perpetually shifting underfoot.
At the heart of Perry’s analysis is a stark warning about federal Medicaid policy. Sweeping cuts—amounting to a trillion dollars over ten years—represent what he called “not just draconian, but something very, very new.” While nursing homes managed an exemption from the most direct provider tax cuts through concentrated advocacy, Perry cautioned that Congress had strategically passed responsibility to governors and state legislatures. The fight for Medicaid dollars has migrated to the states, demanding that industry advocates “get loud and start advocating now.” For assisted living operators, the uncertainty is even more pronounced, as optional waiver programs could come under threat in the face of shrinking budgets and competing lobbies.
The environment is not without its small victories, though even those wins are tempered by the broader sense of unpredictability. A major reprieve for providers arrived with the delay—and probable reversal—of the Biden administration’s minimum staffing regulations, a development Perry called “fantastic news” for a sector already struggling with workforce shortages. At the same time, there is cautious optimism that recent moves by HHS suggest a pivot away from the relentless regulatory posture of past years toward a more pragmatic, perhaps even deregulatory, stance. Still, Perry reminded his audience, “time will tell” what this evolving focus will mean in practice.
On the regulatory front, changes to certificate-of-need laws and the continued push for value-based care further complicate the landscape. Some proposals, such as defunding states that retain certificate-of-need regulations, threaten to fracture industry alliances and place new pressures on capital providers and operators alike. Perry flagged these dynamics as the next arenas for advocacy and adaptation, especially as chronic health management and value-based purchasing move to the fore.
Elections, inevitably, cast a long shadow over every decision. With midterms looming and polarization at historic highs, Perry warned of new risks, including potential investigations into assisted living quality and renewed efforts to drive a wedge between “Wall Street” and “Main Street.” The specter of automatic Medicare cuts, triggered by deficit spending, adds yet another layer of threat that, while historically patched by Congress, remains unresolved until action is taken. As Perry framed it, “until it’s fixed, it’s not fixed.” The pendulum swing between regulatory zeal and deregulatory fervor makes it impossible to predict what the landscape will look like beyond the next cycle, let alone the 2028 presidential race.
Ultimately, Perry ended with a call to purposeful engagement over passive victimhood.
“The lobbying effort at the state level of our generation [in] the next 10 years is going to be fighting for fewer and fewer dollars,” he asserted, underscoring the need for the industry to unite, adapt, and advocate relentlessly. In a time where chaos itself has become a political strategy, senior housing stakeholders no longer have the luxury of waiting for stability—they must treat chaos as the new normal and organize accordingly.
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