The mid-terms are over. While votes are still being counted and some tight races may not be decided for days or weeks, one thing is clear: healthcare was the number one issue. However, it remains unclear what that will mean. Here are five knowns and unknowns.
Known: Repeal and replace is dead
For nearly a year, Democratic candidates across the country focused on one message: healthcare. That focus paid off as Democrats flipped at least 32 congressional districts (counting continues) in last week’s election. The Democratic takeover of the House ensures legislative attempts to repeal or replace the Affordable Care Act – which Republicans dramatically failed to do in 2017 – are dead. Sadly, it’s also unlikely that a divided and polarized Congress will cooperate on legislation to address its flaws.
Unknown: Will the ACA survive
While Congressional stalemate is a near certainty, there may still be fireworks. In the short-term, look for action in the courts. In September, attorneys for twenty states argued in federal court that because Republicans in Congress repealed Obamacare’s individual mandate penalty in their 2017 tax bill, the mandate is now unconstitutional — and so is the rest of the law. The Justice Department has refused to defend the law, resulting in seventeen democratic attorney generals from pro-ACA states stepping in to do so.
Known: Expanded Medicaid is popular even in deep red states
Hundreds of thousands in deep red states will now qualify for health coverage through Medicaid as a result of the election. Voters in Nebraska, Idaho and Utah passed ballot measures to expand their programs and elected pro-expansion governors in Kansas, Maine and Wisconsin. This success at the ballot box significantly increases the chance voters in non-expansion states will have to face similar proposals in the 2020 elections.
Unknown: Who will pay for it
At the same time, voters in Montana and Alaska, which previously expanded their Medicaid programs, expressed major concerns about how it’s funded. In Montana, voters opposed a measure to fund expansion through increased tobacco taxes, albeit it after tobacco companies spent a record $17 million on a no campaign. In Alaska, voters elected a new Republican governor who ran on a promise to review their Medicaid
Other expansion states will also face decisions on how to fund their programs. The federal match for some portions of the Medicaid population is scheduled to drop on January 1, 2020. In Arizona, where expansion is funded by an assessment on hospitals, costs may increase by approximately $80 million annually.
Known: Medicare-for-all and Medicaid-buy-ins will continue being discussed
Neither the president nor Republican-held Senate are likely to support Medicare-for-all anytime soon; however, it will undoubtedly be a common refrain for the next two years. The field of prospective candidates seeking the 2020 Democratic presidential nomination will undoubtedly include more than one vocal proponent.
What healthcare topics do you think will take center stage as a result of the midterm elections? Share your thoughts in the comments section below. Facilitating the discussion of how we can become the Healthiest State in the Nation is the first step to success.