Patient Support & Advocacy

5 ways the midterms shook up the U.S. health care agenda for 2019

Polls said health care was the top issue on voters’ minds, but whether a divided Congress can work with President Donald Trump to address the public’s concerns remains to be seen—though some issues, such as curbing drug prices, have bipartisan appeal.

That is the well-considered view of AMA experts such as Richard Deem, the Association’s senior vice president for advocacy, and Todd Askew, AMA director of congressional affairs.

“Voters went to the ballot box thinking about health care,” Askew said, adding that their most important health care concerns were cost, access, coverage and Medicare issues.

Health care was considered the most important issue of the Nov. 6 election—ahead of the economy and immigration, according to a Gallup poll conducted Oct. 15–28.

“It grew in importance to voters throughout the cycle, and peaked right around election day,” Askew said. “Exit polls really confirmed this as well.”

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People have come to appreciate the coverage gains realized under the Affordable Care Act (ACA) and the law’s Medicaid expansion, Askew explained. Democratic candidates embraced those issues and were successful in “tagging” Republicans with not supporting guaranteed coverage of pre-existing conditions.

Importantly, voters approved Medicaid expansion in Utah, Idaho and Nebraska. Medicaid was also an integral issue in the Florida, Georgia, Kansas and Wisconsin governors’ races.

Askew and Deem took part in an AMA Council on Legislation educational session at the 2018 AMA Interim Meeting. You can hear more from them in an upcoming episode of the AMA “Moving Medicine” podcast. Subscribe now in iTunes.

These AMA experts noted five areas in which the election results could shape the nation’s health care agenda.

ACA repeal efforts. While some Republicans may want to continue down the repeal-and-replace path, Democrats in the House will stop them. Likewise, Democrats may try to reverse some of the actions Republicans took to dismantle the ACA.

Deem noted that previous bipartisan proposals to help stabilize the individual health insurance marketplace may be resurrected—such as funding for cost-sharing reduction payments. Learn about the AMA’s vision on health care reform.

Prescription drug prices. While approaches may vary, some sort of limited action could occur as both sides have an interest in the issue. Patent reform or more price transparency may have bipartisan appeal.

“The Speaker of the House and the White House may reach an agreement on this because this is an issue that all Americans are concerned about,” Deem said.

Find out how prescription drug prices are determined and how the AMA’s TruthinRx campaign is pushing for more transparency in the process.

Gun violence. While some proposals may get through the House, efforts may stall in the Senate. Askew noted that Democrats could schedule hearings on measures to address the public health threat of gun violence and seek to renew CDC funding for gun violence research as step in a broader prevention strategy.

The AMA has adopted policy that gun violence represents a public health crisis and requires a comprehensive public health response. Deem said the AMA supports funding for gun-violence research by the Centers for Disease Control and Prevention. Advocating for expanded background checks is another item the AMA will be pursuing in the next Congress.

The opioid epidemic. More states will follow Pennsylvania’s lead and adopt policies opposing prior authorization for medication-assisted treatment for opioid-use disorder, Deem predicted. The AMA has engaged with insurance regulators, Medicaid directors and behavioral health providers to develop a playbook to share with other states. Learn more about how the AMA is turning a spotlight on state responses to the epidemic, beginning with Pennsylvania.

Changing committee leadership’s effect. Leadership lineups are being shuffled in both chambers by both parties. This could affect how heavily health care legislation is promoted. Most notably, Sen. Charles Grassley, R-Iowa, is giving up his chairmanship of the Judiciary Committee to chair the Finance Committee, which deals with Medicare and Medicaid. Grassley previously led the panel from January 2003 to January 2007, and let it be known he was open to taxing nonprofit hospitals.

Health care impact of the border-wall debate. A “big fight is likely” over funding of a wall on the U.S. border with Mexico that could consume the attention of Congress, the money available for other needs and possibly even lead to a government shutdown, Askew said.

  • Regulatory relief.
  • Immigration issues such as reducing the huge backlog of visas to be processed.
  • Prior-authorization relief.
  • Medical student-loan funding.

“Our priorities haven't changed,” Deem said. “Clearly, we are going to continue to advocate very firmly for expanding coverage, maintaining the safety-net programs, and making sure that there is better health equity in this nation.”

You can stay on the political pulse of the key national and state issues that affect patients and physicians with exclusive coverage in the AMA’s Advocacy Update newsletter. Subscribe today.

To connect with experts and be a more effective physician advocate, register now to attend the AMA State Advocacy Summit in January 2019 and the AMA National Advocacy Conference in February 2019.