Whether you predicted a wave of change, modest political realignment or more of the same, the 2018 U.S. midterm elections reinforced one important reality: Healthcare will continue to be one of the most critical issues for Americans, politically and personally.
Roughly 41 percent of voters in a nationwide exit poll said that healthcare was the most important issue for them, beating out immigration, gun policy, and – for the first time since the financial crisis – the economy for the title of U.S. voters’ biggest concern. Democrats capitalized on that reality to take back control of the U.S. House of Representatives while Republicans increased their majority in the Senate, paving the way for a new political reality in Washington and at the state level. Here’s a forecast of what to expect for health policy in the next Congress:
1. Passing legislation without bipartisan support will be much harder
- ACA repeal: In a divided Congress, the longstanding Republican goal of repealing the Affordable Care Act (ACA) shifts from critical GOP focus to moot point. Asked about the possibility of further attempts, Senate Majority Leader Mitch McConnell (R-Ky.) remarked, “I think it’s pretty obvious that a Democratic House is not going to be interested in that.”
- Medicare for all: While the issue of single-payer healthcare became a progressive rallying cry for many on the campaign trail, prospects for federal policy movement are highly unlikely. Any form of “Medicare for all” passed by the House – which isn’t expected in the near future – would meet a swift end in the Senate. Congressional Republicans have blasted the concept as a government takeover of health insurance that would bankrupt Medicare, or as President Trump put it, “cut Medicare to pay for socialism.” With Sen. Bernie Sanders (I-Vt.) and Congresswoman-elect Alexandria Ocasio-Cortez (D-N.Y.) as media-friendly champions, look for debate around the relatively new idea to continue and eventually pick up steam when Democratic presidential primaries begin.
2. House and Senate priorities will align in places, but not many.
Where they might work together:
- Drug pricing: McConnell and likely-Speaker of the House Nancy Pelosi (D-Calif.) both noted that the parties share a desire to reduce pharmaceutical costs, which is also a top priority for President Trump. McConnell said he “can’t imagine that won’t be on the agenda,” and Pelosi called passing legislation on the issue a “caffeinating issue” for her caucus, adding that “we believe we have a responsibility to seek common ground.” All of this said, the prospect for advancing any drug pricing legislation with support in both chambers remains unclear.
- Marijuana policy: A national Gallup survey in October found that 66 percent of Americans support legalization. While a broader decriminalization of marijuana would likely face tough odds in the Senate, House Democrats seem optimistic that they can drum up enough support to push something through now that two of the biggest opponents to marijuana reform – former Rep. Pete Sessions (R-Texas) and former Attorney General Jeff Sessions – are no longer in positions to halt their efforts.
Where they’ll clash:
- Oversight and investigations: House Democrats have been very clear about their intent for action on a number of investigations focused on the Trump administration and industry actors, many tied to healthcare. Notable areas they’re likely to investigate include:
- The Department of Justice’s refusal to defend the ACA against a lawsuit brought by Texas and 20 other states, which argues the ACA is unconstitutional and should thus be dismantled
- The Trump administration's health regulatory agenda, broadly.
- Recent drug price increases, though this could potentially generate support from Republicans.
3. Opportunities for broad bipartisanship do exist:
- Addressing maternal health: The U.S. maternal mortality rate more than doubled between 1987 and 2014, according to the Centers for Disease Control and Prevention, and more American women die from pregnancy-related complications than in most other developed countries. This issue is already in focus for a bipartisan group of senators, who sent a letter to Health and Human Services Secretary Alex Azar last month asking that the agency “focus on strategies to reduce maternal mortality rates in the United States.” Given the record number of women who will serve in Congress come January, we expect women’s health to be elevated across the board, and improving maternal health is a common-ground issue both parties can support.
- Biomedical research and innovation: Support for the National Institutes of Health (NIH) is one area there have always been champions for on both sides of the aisle. Rep. Nita Lowey (D-N.Y.) will likely chair the House Committee on Appropriations and has been a strong advocate for increased funding for research on diabetes, Alzheimer’s and other disease areas as well as pandemic preparedness. Both Republicans and Democrats pushed back on the Trump administration with vocal support for increases to the NIH budget. This will almost certainly continue if Rep. Lowey takes the helm of House Appropriations.
- Opioids: The recently signed opioid package is one of the few examples of bipartisan action on healthcare this past year. Congressional Democrats feel that more needs to be done on opioids solutions, particularly around funding, a sentiment shared by Congressman-elect Guy Reschenthaler (R-Pa.) and likely House Ways & Means Committee Chair Rep. Richie Neal (D-Mass.).
With the past year defined by an unprecedented degree of political uncertainty and discord, mapping out a sensible path forward can seem challenging for any organization. An opportunity exists to set a course for 2019 action with a focus on engaging inside the Beltway and across the country with purpose. By putting the divisive issues and tone of the past year behind us, healthcare companies, foundations and nonprofits can take a leadership stance in uncovering common ground, helping the health sector collectively advance meaningful solutions with a collaborative approach for January and beyond.
Courtney Gray Haupt is general manager, Sectors & Healthcare, Washington, D.C.
Campbell O’Connor is an account executive, Healthcare, Washington, D.C.