What Do the Midterm Elections Mean for Healthcare?

More than 100 million voters — 49 percent of eligible Americans — turned out for a highly contested midterm election, the largest number to date. Pundits predicted a #BlueWave in which Democrats would gain the majority in both the House and Senate. Ultimately, Republicans maintained their hold on the Senate while Democrats claimed the majority in the House.
Healthcare was the hot-button issue on this year’s ballot. Talks of scaling back coverage for pre-existing conditions motivated many voters to head to the polls. A survey from the Washington Post-Schar School found that healthcare was a high priority for most voters with 41 percent naming it as their first- or second-most important issue, especially among Democrats, 77 percent of whom favored the issue compared with 22 percent of Republicans.

So what were the specific issues that led to record turnouts?

Medicaid Expansion

Medicaid expansion, which the nonpartisan Government Accountability Office has correlated to better health outcomes, was on the ballot in four states: Montana, Nebraska, Idaho, and Utah.
Voters in Nebraska, Idaho, and Utah opted to expand Medicaid coverage under the Affordable Care Act (ACA) to include adults with incomes that are below 138 percent of the federal poverty level, raising the bar from $12,060 to $16,643. Together, Nebraska, Utah, and Idaho could extend Medicaid coverage to approximately 300,000 individuals. Utah would fund the expansion by increasing sales tax 0.15 percent. Expansion is correlated with governors’ support, the single-biggest factor. The general public largely supports expansion efforts, even in regions that — at a legislative level — oppose it.
Montana did not vote in favor of the expansion, though the state had already expanded coverage by 129,000 individuals in 2015.

National Initiatives

The Democrats’ control of the House will likely halt attempts to repeal the ACA, at least for the next two years. The protection for pre-existing conditions is likely to remain, a measure that protects an estimated 102,000,000 Americans.
However, a split Congress creates uncertainty as to whether new initiatives such as increasing consumer protections or curtailing drug costs will advance. It is too soon to tell what resolutions and revisions — if any — legislators will make to the ACA. The current administration has so far repealed the individual mandate and attempted to promote short-term health plans that do not need to comply with certain ACA requirements.
Curbing drug prices is an issue that may attract bipartisan support. The Trump administration recently announced a plan to lower Medicare Part B drug prices by anchoring the prices to an international index. Another Trump initiative aims to display drug costs in TV advertisements. Reform, if it is actualized, is likely to take the form of adjustments to rebates pharmacy benefit managers receive from drug manufacturers.

Miscellaneous Health Initiatives

• Massachusetts – A measure that would mandate specific, mandatory nurse-to-patient ratios was declined by voters. The measure would’ve secured one nurse to every one to five ED patients and a 1:1 ratio for new mothers and newborns. A $25,000 fine per violation, per day, would also have been put in place for employers to enforce the proposed law.
• California – Proposition 4, which authorizes 13 children’s hospitals to borrow $1.5 billion for infrastructure, passed with 61 percent of the vote.
• Nevada – Two-thirds of Nevada voters decided to exempt medical equipment from sales taxes. The measure specifically concerns durable equipment such as oxygen delivery tanks, mobility devices, apnea monitors, and other products.
• Oklahoma – Question 793, which would alter the state’s constitution to allow retail stores such as Walmart to open optometry clinics, was shot down by voters.
  
• Montana – Montana voters opted not to support a cigarette tax that would fund Medicaid expansion. The tax, which would add $2 per pack, drew more than $17 million in opposition funding from tobacco companies. Montana originally expanded Medicaid in 2015, authorizing it for four years. 

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