The 116th Congress was sworn in at noon on Wednesday, January 3, 2019. The Senate remains under Republican control but the House of Representatives is now firmly in the grasp of the Democratic Party. How the business of legislating flows between the two houses remains to be seen, but it is fair to assume that health policy will be a focus for the new Congress. A Kaiser Family Foundation poll taken before the 2018 midterm election reported that seven in ten voters (71%) indicated healthcare as “very important” in making their voting decision. In comparison, 64% said the same about the economy and jobs, 55% about immigration, and 53% about tax cuts and tax reform.
Since the passage of the ACA in 2010, the Republican controlled Congress tried to repeal it dozens of times, or proposed legislation that would further harm the law as opposed to fix what wasn’t working and strengthen what was working. The recent tax legislation zeroed out the penalty for not carrying health insurance, further harming the marketplaces and the options for consumers.
But across the country, Medicaid expansion is experiencing a boom in response to the 2018 elections — voters in Idaho, Nebraska, and Utah approved ballot initiatives to expand their programs; Maine’s new governor has promised to implement the voter approved expansion that was blocked by the previous governor; and other states now have governors and legislatures that are friendly towards expansion.
While there are many health policy issues that need to be thoughtfully addressed, we predict that two areas of healthcare will take precedence when Congress gets to work.
Reigning in prescription drug costs
Six in ten Americans take a prescription and 80% say the cost of drugs is unreasonable. One bill authored by Sen. Elizabeth Warren and Congresswoman Jan Schakowsky targets generic drugs, which are supposed to be lower-cost alternatives to brand name drugs. But in recent years, genetic drug prices have surged — this proposed bill would allow the federal government, under limited circumstances, to produce more affordable versions of generic drugs. There is no question that many proposals to lower the cost of prescription drugs will be batted around this Congress. In her first address as Speaker of the House, Congresswoman Nancy Pelosi outlined an agenda to “lower health care costs and prescription drug prices and protect people with pre-existing conditions…”.
Medicare Reform and Expansion
Even before this Congress gets off the ground, there are at least 5 competing plans from the Democrats to expand government healthcare programs. Medicare reimbursement rates are typically lower than rates set by private insurers, but doctors still accept them because of the sheer number of individuals on Medicaid — 45 million Americans, or 14% of the population. All of these bills originated in the Senate last Congress, but Democratic control of the House makes it more likely that it will be the setting of movement on this issue. On her first day as Speaker, Nancy Pelosi committed to holding the first ever hearings on Medicare-for-All legislation.
Healthcare as an issue was a major concern for voters in the midterm election and carried many candidates to victory. It is likely that, once sworn in, these now-Members of Congress start working to identify flaws in our current health policy (including the ACA) and quickly produce proposals to strengthen and fix our healthcare system. Whether they become law is harder to predict, but the diversity of backgrounds and ideas in the 116th Congress will, no doubt, bring about a wealth of ideas for improving care, lowering cost, and increasing access to providers.