The Verdict is In: 2018 Midterm Election was a Health Care Wave

On November 6th, we saw a “Health Care Wave” sweep across the country altering the balance of power in Washington and across state capitols across the country. Exit polls revealed what we long suspected: health care was one of the most important issues on the minds of voters, and in particular people who voted for Democrats. Democrats, who needed 23 additional seats to retake the House of Representatives, have gained are on track to gain at least 35 seats. Democrats won in districts across the country but did particularly well in well-educated suburbs where Donald Trump remains unpopular and where health care was a top issue for voters.

In the Senate, Democrats went into Election Day defending 27 of the 35 seats up for election this year. Democrats were able to win at least 24 of those races…no small feat, but not enough to make gains in that chamber. In all, Republicans have picked up a net gain of at least two seats with the race in Florida in recounts and the race in Mississippi going to a runoff in December. Republicans are likely to win both.

The ballot initiatives in Idaho, Nebraska, and Utah were the clearest signs that the public supports the idea that health care coverage a critical need in the 21st century. Efforts to expand Medicaid coverage failed in each of the states because of opposition by governors or lawmakers since 2010. In Idaho and Nebraska, voters elected Republican governors and voted to expand Medicaid on Nov. 6. In Utah, former GOP Presidential nominee Mitt Romney won election to the U.S. Senate in the same election that Utahans funded and expanded health care coverage.

The implementation of these expansions will be taken up by state lawmakers in the 2019 legislative sessions. It is also likely to be on the legislative agenda in Kansas and Wisconsin, two states where Republican governors that opposed expansion will be replaced by Democrats who support it. If these states approve the expanding coverage, the number of holdouts will drop to a dozen, mostly Southern states, unwilling to provide the care for low-income adults and families.

The newly elected Congress now comes to Washington on the health care wave and we expect a significant amount of legislative and oversight activity, in addition to the “must pass” health care legislation that has to be dealt with in the fall (funding for Community Health Centers, cuts to Medicaid Disproportionate Share Hospitals, and enhanced Medicaid funding for Puerto Rico all expire on Oct. 1).

House Democrats are interested in working on legislative priorities in several health care-related areas during their first several months, including legislation to curb rising drug costs; surprise billing, and efforts on addressing substance use disorder with a particular focus on increasing funding for treatment of SUD. These efforts do have bipartisan champions and may stand a chance in the Senate as well.

House Democrats are also very interested in moving legislation to stabilize the ACA’s marketplaces. Bipartisan negotiators were within a few votes of passing stabilization last spring before it was tanked at the last minute over extraneous provisions. While the legislation will focus on marketplace stabilization, if it advances, it could provide a useful legislative vehicle for related bipartisan health provisions.

The House Democrats are also preparing oversight actions to counter the administration’s regulatory efforts to the extent possible. The incoming majority is preparing a series of oversight actions in the health care space that they hope will both uncover ill-advised regulatory decisions and help to slow down the rulemaking process. In particular, they are interested in investigating the administration’s work on Short Term Plans; Section 1332 ACA waivers; and Section 1115 Medicaid waivers (including work requirements).