The 2022 midterm elections are all about who will control Congress for the next two years, and who controls Congress will have significant impact on health policy.
That was the key takeaway from a Manatt Health webinar on what the midterm elections will mean for health care.
The three main webinar themes were:
Elections matter. Congressional elections will set the stage for health reform activity over the next two years, as many initiatives either have been sidelines as the Democratic party negotiated the Inflation Reduction Act or have languished in a gridlocked Senate.
Further consolidation of state policy. State elections will likely lead to more state trifectas (where one party controls the governorship and the state legislature), and more partisan state health policy and laws.
The courts and the executive branch will have a say. The Biden administration and the courts will continue to put their stamp on health policy. Major health policies will arise out of federal action, although that action will be constrained by the federal courts’ willingness to strike down agency actions. This will give courts more impact than usual in rolling back federal agency powers and established precedent.
Health reform is a top issue for voters, but Democrats and Republicans differ on their health reform priorities, said Tara Straw, Manatt Health senior advisor. Abortion rights and reproductive health care issues in the wake of the Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling are the top health care concern for Democrats, followed by expansion of Medicare and Medicaid coverage. Republicans’ top health care concerns are increasing choice and competition, and increasing investments in science and medicine.
“Both parties talk about lowering health insurance premiums but have different ideas on how to do that,” she said.
With both parties in Congress so far apart in their health care priorities, Straw said, any legislative successes will be limited to narrow, bipartisan issues. Those issues include behavioral health initiatives, increasing access to telehealth and limiting out-of-pocket spending on insulin in commercial coverage.
State elections matter
Most health reform issues begin at the state level and then move to the federal level, said Joel Ario, Manatt Health managing director. The midterm elections also will impact which party will be in control of the states, with 36 states having a gubernatorial election in November.
Partisan control of state government impacts some health reforms more than others, he said.
In the 13 states where the legislature and the governor are of different parties, the governor is up for election in eight of those states. Of those split-control states, three states have not expanded Medicaid, six states have state-based health insurance marketplaces and two states have banned abortion.
Fourteen states have a Democratic governor and a Democratic-controlled legislature. In those states, 11 have gubernatorial elections in November, all 14 have expanded Medicaid, 11 have state-based marketplaces and all 14 states allow abortion.
Currently, 23 states have a Republican governor and a Republican-controlled legislature. Fifteen of those states will elect a governor in November. Nine GOP-controlled states have not expanded Medicaid, two have state-based marketplaces and nine states have banned abortion.
Health care issues that have bipartisan support on the state level, Ario said, include increasing access to primary care, behavioral health and postpartum coverage; prescription drug affordability, and cost control initiatives.
Where the courts will weigh in
The Senate shapes the president’s ability to alter the makeup of the federal courts, Straw said, as the Senate confirms the president’s judicial nominees. The next health care issue the Supreme Court will decide is Health and Hospital Corporation of Marion County, Ind. v. Talevski, which will determine whether Medicaid beneficiaries may sue state officials for violating their federal rights. Arguments are scheduled for Nov. 8.
Other issues pending before the court include the Centers for Medicare and Medicaid Services’ COVID-19 vaccine mandate, federal limits on long-term care arbitration agreements, generic drug labeling and infringement claims, and drug patent specifications.
Health issues pending in U.S. district and appeals courts include an employer challenge to insurers’ requirement to cover preventive services with no cost-sharing, and state attorneys general seeking to vacate the Trump administration rule relaxing requirements for association health plans.
Other federal action
Implementing the Inflation Reduction Act will be a major focus at the federal level, said Adam Finkelstein, Manatt Health counsel. The Biden administration will tout the act’s benefits for seniors while implementing the new law, Finkelstein said. Meanwhile, congressional Republicans may look for flaws in the law or its implementation in order to attack or hold hearings on the law.
Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.