Bloomberg Tax
April 10, 2019, 1:50 PM

INSIGHT: Providing Long-Term Care in America Just Got Harder Under New Tax Law

Mark Parkinson
Mark Parkinson
American Health Care Association

America’s long-term care profession is facing a dire financial crisis. With many nursing homes already being forced to close their doors for a multitude of reasons, there is now additional financial pressure on the horizon for providers following the passage of the Tax Cuts and Jobs Act last year.

Most signs indicate the economy has improved under the new tax law. Unfortunately, long-term care providers aren’t sharing in the benefits. More than 15,000 nursing homes and nearly 29,000 assisted living communities across the country provide care to millions of people, many in smaller, rural communities. Every year, millions of people depend on local long-term care providers for vital health care services they need and deserve.

The economy is getting stronger. So what’s the problem?

Nursing homes and assisted living communities have long-relied on deducting loan interest payments before paying taxes. This interest deduction is vital because our businesses are capital-intensive. A nursing home can’t exist without a significant real estate investment. Every business owner knows that large capital investments require financing, which generates large interest payments.

The new tax law limits interest deductions for all but certain types of businesses, including so-called “real property trades or businesses.” The American Health Care Association and National Center for Assisted Living asked the Internal Revenue Service for clarity on whether businesses that own the real estate associated with long-term care providers can continue to deduct all their interest. In December 2018, the IRS issued a proposed rule that was clear: long-term care providers are prohibited from taking the interest deduction.

The proposed rule is devastating for long-term care providers. Unlike other industries, long-term care providers cannot offset this new tax burden by taking advantage of other benefits provided by recent changes in federal tax law. For example, most providers cannot take advantage of recent reductions in the corporate tax rate or the new deduction for pass-throughs.

We have already seen an increase in the number of nursing home closures in recent months and years, and the additional financial burden of paying more taxes will only add to this crisis. A recent New York Times article highlighted the industry’s financial struggles, particularly in heavily rural states like South Dakota. The shortfall in Medicaid reimbursement in that state results in a loss of $58 per day for each resident on Medicaid in a nursing home. This adds up to $66 million a year in losses statewide. More than half of long-term care in the country is covered by Medicaid, and underpayment is not a problem unique to South Dakota.

Anytime a nursing home closes, especially in a rural area, there is a direct impact on those who need these services. Even providers that are doing well face significant financial challenges under the new tax law. When it becomes necessary to find money to cover additional expenses like higher taxes, you take away the ability to do the things that keep businesses strong and help them grow. It impacts employees when you cannot provide decent wages for much-needed jobs or offer pay raises for outstanding employees. It means the appropriate and necessary capital improvements cannot be made.

We need solutions that help improve and expand long-term care, not hinder it. It is vital that the Department of Treasury and the IRS address this problem and provide long-term care providers the ability to build and expand their businesses.

Millions of Americans are depending on it.

This column does not necessarily reflect the opinion of The Bureau of National Affairs, Inc. or its owners.

Mark Parkinson is the President and CEO of the American Health Care Association and National Center for Assisted Living.

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