With less than two weeks until the midterm elections, many Americans are wondering how their daily lives may be impacted by the outcome at the polls. One of the most important issues for voters is health care, and the two major political parties are at odds about how this complex and critical industry should be organized and overseen. There is plenty of uncertainty about what the election holds, but there is no doubt that the decisions made on November 6 will have a direct impact on the accessibility and delivery of care.
The Affordable Care Act
For the better part of 2017, a Republican-controlled Congress and White House tried to repeal the Affordable Care Act (ACA). Although they were able to rollback provisions such as the individual mandate, Republicans were ultimately unsuccessful at fully repealing the law. If the Republicans maintain control, they might revisit their attempt. In contrast, Democrats say they intend to protect popular provisions of the ACA—such as protections for people with preexisting conditions—if they win enough seats to take control. But no matter which party is victorious, the ACA is at risk as President Donald Trump is in favor of repealing the federal statute.
Health care costs, Medicare and regulatory burden
Should Democrats gain control of one or both chambers, they will likely make an aggressive effort to impose oversight on—and potentially investigate—the administration’s actions. Their focus will likely be on health care and pharmaceutical costs and less on reducing regulatory burden (a drumbeat of the current administration). Democrats are also increasingly embracing a “Medicare for All” plan, but the party has yet to unite around what that means. Options range from Senator Bernie Sander’s full-scale single-payer system proposal to an optional buy-in for individuals over a certain age.
State races will also play a part in health care access for individuals. Seventeen states have not expanded Medicaid under provisions in the ACA and it has become an issue in gubernatorial races, as well as, a referendum question on some state ballots. On Election Day, voters in Idaho, Nebraska and Utah will decide whether their states should expand the program. Voters in Montana will determine whether their state maintains its expansion. In the Florida, Georgia and Wisconsin gubernatorial races, expansion is an issue because those states have previously not expanded Medicaid. After November 6, we will continue to see high variation across states’ waivers to the Centers for Medicaid and Medicare (CMS) regarding how they run their individual programs.
Should Republicans remain in control of both chambers, we’ll likely see continued efforts to address regulatory burden. One area where congressional Republicans have concentrated their efforts as of late is updating the Stark and anti-kickback laws, which proponents argue impede the drive toward a value-based payment system. Payment reform is a priority for the entire GOP. Health and Human Services (HHS) Secretary Alex Azar highlighted the value-based care initiative as one of the administration’s four priorities when he was first confirmed. We have already seen efforts to move the needle under Seema Verma at CMS and Adam Boehler at the Center for Medicare and Medicaid Innovation (CMMI). Other priorities that drive the work at HHS include improving availability of health insurance, lowering the cost of prescription drugs and addressing the opioid crisis.
Opportunities for bipartisanship
No matter the outcome of the election, bipartisan proposals have the best chance of becoming law. Compromises might come in areas of rural healthcare and increasing quality outcomes. The rising cost of healthcare—with a continued focus on pharmaceutical costs, and reforms to the 340B drug program and Part D drug negotiations—are other topics that could draw consensus on both sides of the aisle. Increasing consumer transparency and engagement is another area that is ripe for consideration.
The results of the upcoming U.S. midterm elections will have long-term effects on the direction of health care. The political party that manages to sway most voters will have the ability to enact legislation that will affect the well-being of millions of individuals and entire communities.