Brendan Williams is the president and CEO of the New Hampshire Health Care Association.

In attacking nursing home care, President Biden has implied it’s lucrative, even though the nonpartisan Medicare Payment Advisory Commission annually reports to Congress that average margins are minuscule to negative. He has proposed an unfunded nursing home staffing mandate projected to cost $6.8 billion a year, toward which his administration will only make a one-time $75 million workforce investment.

The president ignores a national wave of hundreds of nursing home closures since the COVID-19 pandemic began, and only three new nursing homes have opened nationally this year. His own U.S. Small Business Administration has questioned the burden of his staffing mandate proposal. Congressional Democrats representing rural states, including ours, have been vocal in pushing back on the unfeasibility of the proposal.

In neighboring Maine, which has seen facility closures hitting rural communities especially hard, most recently in Belfast, it was announced last month that the plug was being pulled on a new nonprofit rural nursing home project. Why, if President Biden is right about the financial strength of nursing home care?

In Rhode Island, residents desperate to save their half-century-old East Providence nonprofit nursing home reportedly held a bake sale to raise $2,000 toward its $100,000 monthly losses due to inadequate Medicaid reimbursement. No word on whether the president bought cookies to help.

Here in New Hampshire, where even the Veterans Home has contracted with three out-of-state staffing agencies for $4.1 million, providers are beset to find workers. Two county nursing homes have had wait lists of over one hundred prospective residents because they cannot find workers even with wages at record levels. President Biden might learn how impossible his staffing mandate is if he deigned to campaign in the Granite State, which has the nation’s second-oldest population.

Furthermore, the president’s stated concern about accountability for taxpayer dollars going to nursing homes rings hollow, given their audited cost reports and the fact that his administration refuses to use its authority to require that states cover documented Medicaid care costs, which are mostly wages.

Where’s the accountability for the $54 billion that went out to airlines in COVID-19 assistance? Enjoyed your flying experience lately? Under the Provider Relief Fund, the only targeted and unconditional COVID-19 assistance nursing homes received was less than one-tenth of what the airlines received: $4.9 billion. You can also compare that $4.9 billion to the $7.5 billion obtained by the Biden Administration for electric vehicle charging stations. Not one, to date, has been built with this money, which could go a long way toward helping nursing home caregivers. Most do not drive Teslas.

There are achievable things the president could do to help nursing home residents.

He could require that documented Medicaid care costs be paid. He could act on a January 2022 letter from almost 200 U.S. House members asking his administration to investigate predatory practices by nurse staffing agencies which the letter noted “are vastly inflating price, by two, three or more times pre-pandemic rates” – price-gouging impossible for providers limited by government reimbursement to compete with.

He could act on the reported fact that Medicare Advantage insurers are using algorithms to deny nursing home care coverage, even if taking action defies campaign contributors that records show gave him almost three times more than the incumbent president he defeated.

It is not too late to do the right thing. Montana has seen a terrible number of nursing home closures, and, as its Democratic senator, Jon Tester of Montana has stated, “long-term care facilities are already facing severe workforce shortage issues, and this federal staffing mandate could force facilities to shut their doors.”

President Biden should listen to such voices.