Dean Lerner served Iowa as an Assistant Attorney General for sixteen years, Chief Deputy Secretary of State for four years, and about ten years as Deputy Director, then Director of the Department of Inspections & Appeals. He then worked for the CMS Director of the Division of Nursing Homes, and the United States Attorney for the Northern District of Iowa. He is a graduate of Grinnell College and Drake University Law School.
During his interminable State of the Union address, President Donald Trump referred to waste, fraud, and abuse. Of course, such mention was opportunistically political, containing recurrent condemnations of the Somali community, a favorite target of our president’s vile rhetoric.
While waste, fraud, and abuse is a worthy topic and should be condemned and eliminated, a more introspective approach would have better served our nation.
The New York Times recently reported that “[s]tarting in early August [2025], nursing home executives began making donations that would eventually total nearly $4.8 million to MAGA, Inc., a super PAC devoted to President Trump and run by his allies.” After these donations, the Trump administration revoked the rule requiring more nursing home staff.
The Centers for Medicare and Medicaid Services finalized that rule in 2024 after years of research and study, and 46,500 comments.
The nursing home industry did its best to upend the rule during the rulemaking process, but when it failed in this effort it launched multiple attacks on different fronts: legal, political, and otherwise.
No one will be surprised to learn that staffing is the single most important factor in nursing home care. It is known to protect and improve the lives of over 1.24 million residents who make their home in Medicare- and Medicaid-certified facilities.
Staffing is also known to be insufficient, often grossly insufficient, in an unimaginable number of homes. Research shows a direct correlation between poor staffing and poor care. Neglect and abuse are all too common in understaffed facilities. Among other benefits, the rule was expected to save at least 13,000 lives annually.
The American Health Care Association (AHCA) represents thousands of member nursing homes in this mostly for-profit industry funded by untold billions of taxpayer dollars. Private equity ownership, Real Estate Investment Trusts, related party transactions and other organizational schemes are known to prioritize profiteering over caregiving.
The AHCA is one of the most powerful lobbying organizations in our country, and was perhaps the most powerful of the forces dedicated to crushing the rule. It even filed a lawsuit in Texas attacking the rule.
Member nursing homes pay millions of dollars in dues to the AHCA, and are then reimbursed by taxpayer dollars as an allowable expense. The 2024 Form 990 Non-Profit tax return of the AHCA details $24,250,918 in Membership Dues Revenue.
The organization’s president and CEO during this time reported his salary and benefits of $2,411,285. It is unknown as of yet what the new president and CEO, Clifton J. Porter II, will earn from his efforts. However, an AHCA news release from December noted that he “has been recognized as one of this year’s Top Lobbyists by The Hill, a prestigious award among Washington, D.C. lobbyists and industry leaders.”
Truth be known, AHCA has two primary interests and objectives: 1. More taxpayer money with no accountability, and 2. less regulation. It seems incongruous, to say the least, that we taxpayers should support any organization whose interests are in direct conflict with the health, safety, welfare, and rights interests of the residents of the nursing homes they represent.
In the interests of transparency and curbing waste, fraud, and abuse, perhaps President Trump will share the substance of his conversations with the nursing home executives who so generously donated to his MAGA, Inc. super PAC. Quid pro quo comes to mind.
In addition, perhaps Trump will instruct his administration to prohibit the AHCA and other such associations from receiving a single penny of taxpayer money. Now, that would be worthy of the thunderous applause and adoration he so desperately craves.