Many pundits sifting through the midterm election results predict gridlock in the nation’s capitol in the next two years. This forecast—the equivalent of “don’t bet against the house”—reflects the certainty that a Democratic House will put the breaks on the purely partisan policies of the Republican Senate and White House. The prime example: legislation to repeal and replace the Affordable Care Act (ACA) is dead (for now).
That may be what some voters sought: checks and balances. Yet, other voters who named health care a top concern, more so than any other issue, want action as well. Their mandate to the 116th Congress is to preserve protections for people with pre-existing conditions. They seek relief from the high cost of health care. And there may be opportunities in 2019 to make that happen. Here are seven suggestions on what the incoming Congress could do on health policy.
1. Stop executive actions that undermine pre-existing condition protections.
Progressive lawmakers have introduced legislation that closes a loophole, expanded by the Trump administration, that lets “short-term” plans charge more or deny coverage to people with pre-existing conditions. If the Senate refuses to take up such legislation, the House could add it as a “rider” on an annual appropriations bill. Should that approach fail, the House could prohibit the Department of Health and Human Services (HHS) from using using its funding to develop new regulations—staunching the flow of executive actions that reduce access and raise costs for patients. Furthermore, without Senate approval, the House could use hearings, oversight, and its own litigation to help patients and states defend pre-existing condition protections in the courts.
2. Support down-sized policies to tackle health costs.
The clash between Republicans who want to replace ObamaCare with state block grants and Democrats who want to preserve the ACA and expand Medicare-like plans will continue on the battleground of the 2020 presidential election. Beneath the din, it is possible for Congress to act on lower profile health legislation with little fanfare. Some may be bite-sized: for instance, one bipartisan bill would tackle the “surprise medical bills” that insured people get when they go the hospital and discover one of the doctor’s bills is not covered. Others could aim to ease concerns about high deductibles (for instance, requiring primary care visits or generic drugs below the deductible) or premiums (for instance, reinsurance programs). Senate majority leader McConnell indicated a post-election openness to unspecified bipartisan ObamaCare fixes.
3. Decrease prescription drug costs.
President Trump, in his press conference the day after the election, declared his interest in working with Democrats on prescription drug costs. This issue, like pre-existing conditions, was a factor in the midterms. There are numerous ideas in this space, from increasing price transparency to improving Medicare’s drug benefit to some form of price negotiation. Finding common ground is possible and even probable.
4. Fund health priorities through the annual appropriations process.
The budget for the Department of Health and Human Services (HHS) is appropriated annually. It contains hundreds of programs whose impact would be amplified with increased funding. The House could, for example, restore funding for outreach and enrollment in the Health Insurance Marketplaces (cut by the Trump administration). It could also prioritize other health policy priorities such as increasing funding for the program authorized to treat people with opioid addiction, or by directing funds to address high maternal mortality. The importance of health care in electing the incoming Congress will likely be reflected in the HHS budget.
5. Consider health infrastructure.
Another bipartisan priority for the next Congress may be investment in the nation’s economic infrastructure. The health sector could be included in this legislation as well. For example, public health capacity is weak in some areas, putting residents at unnecessary risk (e.g., uncontrolled infectious diseases, or food or water poisoning as in Flint, Michigan). Investing in public health infrastructure could yield health and economic dividends.
6. Encourage states to expand Medicaid.
One concrete result from the midterms is the likely expansion of Medicaid in three states due to ballot initiatives (Idaho, Nebraska, and Utah) and two more through new, supportive governors (Kansas and Wisconsin). An estimated 381,000 uninsured could gain coverage in these five states. Yet, in states like Florida, the prospects for Medicaid expansion are dimmer now than they were before the election. Members of Congress could introduce bills that close the Medicaid “gap” in coverage, such as allowing cities and counties (rather than states) to expand the program. While unlikely to be passed in the Senate—Congress rarely takes quick and decisive action on a topic as complicated as health care—they could raise awareness, rally state-based advocacy, and road-test ideas for a more amenable future Congress.
7. Set the agenda for a future Congress and president.
Direct action to improve the health system rarely is like a strike of lightning out of the blue. Instead, it typically results after time spent on documenting problems, developing evidence on solutions, creating supportive coalitions, and generating public support. From 2006 to 2008, the Democratic Congress set the stage for the health reform bill signed into law by President Obama. They did not do so by introducing the ACA in 2006; instead, they laid the groundwork for when they could use the tools of the majority to pass it. There was, for example, a bipartisan Senate Finance Committee summit on health reform called “Prepare to Launch;” also, at the direction of the budget committees, the Congressional Budget Office produced two volumes of cost estimates on health options in 2008. The incoming Congress could do the same, creating specific policy options or proposals, backed with analytics, for when progressives have control of the agenda in Washington, D.C.
These ideas are not exhaustive, nor are they meant as directives: the new congressional leadership will set the strategy to make progress on the health care mandate issued by midterm voters. Instead, these ideas illustrate possibilities and offer a counterweight to the naysayers about the ability of the 116th Congress to make a difference. There is much that they can do in the here and now.