As previously mentioned, reimbursement rates are and have been at the forefront in this industry for years. President Obama's Affordable Care Act (ACA) and Medicare sequestration-related budget cuts put several carriers out of business (FLTCH instituted a 25% across-the-board layoff in 2013). Additionally, policies proposed by President-elect Donald Trump, such as repeal (or more likely reconciliation) of the ACA, could be a boon for the industry, but replacement policies such as sales of Interstate insurance, high-deductible insurance plans and Medicaid block grant funding will make running a senior care facility potentially even more difficult in the years to come