This seems to be the big take-home message from voters in the
mid-term election held yesterday, which bodes well for preserving gains from
the Affordable Care Act and expanding coverage. Health care was the number
1 issue for voters according to several
exit polls, beating out immigration, the economy, and gun violence, among
others, with voters strongly favoring Democrats
as the party more likely to protect patients with pre-existing conditions. Preserving the ACA’s protections for pre-existing conditions arguably may have been the single greatest contributor to
Democrats taking control of the House of Representatives from Republicans,
gaining at least 30 seats.
Yet Republicans not only kept control of the Senate, they also
expanded the number of Senate seats they control, adding at least 3 seats to be
held by members with strongly conservative views. This raises questions about
how much of the electorate’s desire for Congress to act to make health care
more affordable to them and their families will translate into action in
Congress; preserving existing patient protections may be the most likely
outcome.
The story at the state level is very different: more states
seem poised to expand Medicaid coverage; yet on other health care issues, like
women’s access to reproductive services or reducing gun violence, the prospects
at the state level are more mixed.
Here’s my take on five health care issues likely to be
affected by the mid-term election results:
1. Obamacare repeal and
replace is dead. The Democratic-controlled House of Representatives will
not allow legislation to advance to repeal, or repeal and replace, the
Affordable Care Act.
Except . .
.Congress will have to do something to preserve protections for preexisting
conditions, if the courts ultimately rule in favor of a case brought by 20
GOP-led states and supported by the Trump administration that seeks to have the
ACA’s protections for pre-existing conditions ruled unconstitutional. A decision by a conservative Texas judge is imminent
and should he rule for the plaintiffs, as many expect, it will assuredly be
appealed to the higher courts; it may be up to the Supreme Court to ultimately
decide. Stripping pre-existing condition
protections via a court decry will be hugely unpopular with the electorate, and
almost all of those elected yesterday promised to protect them (even when their
own voting records suggest otherwise). However, it’s by no means certain that a
Democratic House, Republican Senate, and President Trump could agree on a path
forward to reinstate them. The best
outcome would be for the courts to find that the case has no merit and rule
against the plaintiffs.
And . . . while
there may be interest in both political parties to advance bills to make the
ACA more affordable for those who are not eligible for premium subsidies
because they earn too much to qualify, it is hard to see a path forward that
could bridge the ideological divide between Republicans and Democrats. House Democrats will also try to advance bills
to overturn the administration’s decisions to allow sale of short-term plans
that do not cover essential benefits, yet such bills likely would die in the
Senate, or face a veto from the president.
States that have elected Democrats as governors and to the statehouses
may pass legislation on their own to ban or regulate sale of short-term plans.
2. More low-income
people will gain coverage from Medicaid
expansion, upwards of half a million of them. Voters approved Medicaid expansion via
referenda in three GOP-leaning states: Idaho, Nebraska, and Utah. The election
results in three other states, Maine, Wisconsin, and Kansas, also bode well for
expansion. Montana voters, however,
voted down a referendum to continue to fund their version of Medicaid expansion
via higher tobacco taxes, potentially placing coverage for their residents at
risk. Republicans elected or re-elected
to the governorships in other states are unlikely to expand Medicaid, and/or
will seek to include work requirements that may make it more difficult for
people to qualify.
3. Prospects for
policies to address the high cost of prescription drugs may advance at both the
state and federal levels. In his
initial remarks today on the midterm elections, President Trump suggested that
common-ground could be found with Congress and the Democrats on lowering the
cost of prescription
drugs. Many Democrats newly elected to the governorships and state
legislative seats favor policies to require transparency in drug pricing.
4. Common-sense policies
to reduce gun violence may be advanced in additional states, as voters
elected candidates to governorships and legislatures who favor such policies; yet in other states, voters elected or
re-elected candidates opposed to such policies. Voters in Washington state approved a
referendum to advance restrictions on firearms. NBC’s exit poll found that 60%
of those who casted votes favored
stricter gun control policies, including 46 percent of gun owners compared to
76% of those who don’t own firearms; just one-in-ten ranked it as the most
important issue facing the country. Democrats are likely to advance gun violence
policies in the House, yet it is unlikely that a more conservative Senate and
the Trump administration will accept them.
On the other hand, the House will almost certainly reject concealed
carry reciprocity, should it be taken up next year by the Senate. (In the current Congress, such legislation
passed the GOP-controlled House, but was not taken up by Senate).
5. It’s a mixed bag for
women’s health. The House of
Representative will not advance or accept legislation to defund Planned
Parenthood and other women’s health clinics.
It may try to advance bills to overturn the administration’s efforts to
allow broad “conscience exemptions” to contraception coverage, yet it’s hard to
imagine those being accepted by the Senate.
With more states under partial or complete Democratic control (governors
and statehouses), bills to ensure women’s access to reproductive services may
fare better in those states than in the past; voters in several other states
yesterday advanced measures to greatly restrict access to such services. For many women, access to necessary services
will depend on where they live.
There are many other issues that are less partisan and may
find common-ground in the new Congress, including improvements in the Medicare
Quality Payment Program, payment for primary and comprehensive care, reducing
barriers to chronic care, addressing the opioids epidemic, and reducing
administrative tasks imposed on physicians and patients.
One thing is sure: voters yesterday ranked health care as
the most important issue behind their votes, and politicians who ignore them,
or let partisan divisions lead to inaction, will do so at their own risk.
1 comment :
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