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Our Take: 2018 Midterm Election: Impact on Health Care

Nov 12, 2018

With several races still undecided, here’s Our Take on the midterm election and its effect on patients, providers and suppliers.

Perhaps the most notable effect of the Democratic takeover of the House is that the Affordable Care Act (ACA) is here to stay.

Three weeks ago, Senate Majority Leader Mitch McConnell, R-Ky., told Reuters that if given the chance—that is, if Republicans remained in control of both chambers of Congress—we could expect another attempted repeal of Obamacare.

But this week, referring to an ACA repeal, McConnell told reporters, “I think it’s pretty obvious, the Democratic House is not going to be interested in that,” adding that he was willing to work on health policy issues on a bipartisan basis.

That’s rich.

Whether you are personally opposed to the ACA or are an Obamacare advocate—or, you don’t have an opinion one way or another—the constant chipping away at Obama’s signature achievement has come to an end. That’s a relief for some Americans that have relied on the ACA and its consumer protections, most notably coverage for pre-existing conditions.

In their numerous attempts at eliminating Obamacare, Republicans misread voters. For many people, the ACA enhanced their sense of safety and security, with pre-existing condition coverage, Medicaid expansion and subsidies for those who couldn’t afford insurance. Taking that away posed a threat to the safety and security of many American families, we believe.

We expect that some of the “fixes” that have come out of the Trump administration might be repealed or regulated by a Democratic House. We don’t expect association health plans or other bargain-basement insurance products that lack ACA protections to survive for long.

That said, a divided Congress means either compromise or inaction on health care. The polls and pundits tell us that voters had health care on their minds when they cast their ballots. The problems we face in health care, including escalating costs everywhere you look, won’t go away without action.

So, over the next two years, we can expect to see one of two things. Republicans in the House and Senate will collaborate with Democrats to fix the problems that are fixable through legislation, with both parties compromising to find solutions. Or, both sides will go to their corners and nothing will get done.

The other consequential effect of the elections is related to Medicaid. Four states had ballot initiatives to approve Medicaid expansion. Three states passed the measure—Nebraska, Idaho and Utah—which will result in health insurance coverage for more than 300,000 lower-income people in those states. The measure failed in Montana, which connected the expansion of Medicaid to an increase in tobacco tax.

With new Democratic governors in Wisconsin, Kansas and Maine, odds are we’ll see expansion coming soon to those states as well. Maine, in fact, already passed a similar ballot initiative that was effectively blocked by outgoing governor Paul LePage.

Finally, there is one industry that should be concerned about the election results, and that’s drug manufacturers. Republicans and the Trump administration already had their sights set on pharma, as we wrote as recently as two weeks ago. With the Democrats in charge, House Leader Nancy Pelosi, D-Calif., said last week that the Democratic priorities are infrastructure and pharmaceutical prices. With both sides having pharma in their sights, it’s hard to imagine a scenario in which pharma doesn’t take a hit.

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