The much-anticipated 2018 midterm elections are over, but the effects on healthcare are lasting.
What’s next? Here, policy insiders share their key takeaways:
1. A wholesale repeal/replace of the ACA is not going to happen in the next two years. “On the other side of the continuum, Medicare For All is also likely dead for the next two years. We’ll see more movement on issues that have bipartisan support, such as pricing and transparency,” says Ben Isgur, PwC Health Research Institute leader.
“This is good news for providers and patients,” says John Driscoll, CEO of CareCentrix, a manager of post-acute services with a core focus of making the home a center of care. “By flipping the House, Democrats can now protect the ACA provisions that Americans value. America may look polarized politically, but is more united than not in expansion of access.”
2. Drug pricing will be front and center. A Democrat-led House Oversight Committee will take full advantage of its subpoena power and hold numerous investigative hearings on drug pricing issues next year, according to Lindsay Bealor Greenleaf, director at healthcare advisory firm ADVI Health. “House Democrats will leverage their newfound oversight authority to draw attention to the issues they want to highlight going in to 2020 to shape their platform, and they’ve made it clear that drug pricing is a top priority issue,” Bealor Greenleaf says. “Since enacting significant legislative reforms will be nearly impossible for Democrats with the Senate still under Republican control, there will be an even greater emphasis on high-profile hearings and investigations. House Democrats have publicly outlined these plans for months, and within hours of winning the House, the likely incoming House Oversight Chairman Elijah Cummings (D-MD) plans to focus investigations on drug pricing and efforts to undermine preexisting condition protections and the Medicaid program.”
3. Money does not talk—it screams—at the ballot box. “An initiative to cap dialysis center profits was defeated in California, with the extraordinary help of over $100 million in industry contributions,” says Driscoll. “DaVita’s market cap soared by over $1 billion in value after the election. In Massachusetts, hospitals invested to defeat a nursing staff ratio ballot question. In both cases, industry outspent their opponents and scored decisive wins.”
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4. House Democrats are expected to pursue several reforms next Congress. “This includes legislation allowing the government to negotiate prices in Medicare Part D, which is essentially government price fixing, as well as expansion of the government’s power to seize manufacturers' patents if they don’t approve of the price,” says Bealor Greenleaf.
5. With a divided Congress, Democrats will bring forward their healthcare ideas. “While notions such as universal coverage will certainly be opposed by Republicans, some common ground may be found in areas such as drug pricing,” says Larry Blandford, executive vice president, customer solutions for Precision Value & Health. “As the move to value-based care is likely another area of bipartisan support, further innovations in reimbursement by CMS should be expected.”
6. More aggressive liberal policies will be non-starters in the Senate since Republicans have maintained control. “However, with Republicans’ slim majority in the Senate and with the retirement of Sen. Orrin Hatch (R-UT), there is potential for other unfavorable reforms to be enacted,” Bealor Greenleaf says.
7. There will be more action on the state level in the next two years. “If there was any ‘winner’ last night, it was healthcare coverage,” says Isgur. “Medicaid ballot initiatives passed in Idaho, Nebraska, and Utah, and we have three new Democratic governors who won who want to expand Medicaid—that’s six new states in play, and could mean up to 500,000 more Americans insured.”