Voters this season have told pollsters in no uncertain terms that health care is important to them. In particular, maintaining insurance protections for preexisting conditions is the top issue to many.
But the outcomes of the midterm elections will probably have a major impact on a broad array of other health problems that touch every single American. And how those issues are addressed will depend mainly on which party controls the U.S. House and Senate, governors' mansions assuring legislatures around the country.
All politics is local, and no single race is likely to determine national or perhaps state action. However, many key contests can offer something of the barometer of what's prone to happen – or not happen – within the next 2 yrs.
For example, keep close track of Kansas. The razor-tight race for governor could see whether the state expands Medicaid to any or all people with low incomes, as allowed underneath the Affordable Care Act. The legislature in that deep red state passed a bill to accept expansion in 2021, however it could not override the veto of then-Gov. Sam Brownback. Of the candidates running for governor in 2021, Democrat Laura Kelly supports expansion, while Republican Kris Kobach doesn't.
Here are three big health problems that may be dramatically impacted by Tuesday's vote.
1. The Affordable Care Act
Protections for preexisting the weather is only a small area of the ACA. The law also made big changes to Medicare and Medicaid, employer-provided health plans and the generic drug approval process, amongst other things.
Republicans ran difficult on promises to get rid of the law in each and every election because it passed in 2010. However when the GOP finally got charge of the home, the Senate and the White House in 2021, Republicans found they could not reach agreement regarding how to “repeal and replace” the law.
This year has Democrats on the attack over the votes Republicans took on various proposals to remake the law. Probably the most endangered Democrat in the Senate, Heidi Heitkamp of North Dakota, has hammered her Republican opponent, U.S. Rep. Kevin Cramer, over his votes in the House for that unsuccessful repeal-and-replace bills. Cramer asserted despite his votes he supports protections for preexisting conditions, but he's not said what he'd do or fall behind that could have that effect.
Polls suggest Cramer has a healthy lead for the reason that race, but when Heitkamp performed a surprise win, health care could get some of the credit.
And in Nj, Rep. Tom MacArthur, the moderate Republican who wrote the word what that got the GOP health bill passed in the House in 2021, is within a heated race with Democrat Andy Kim, who has never held elective office. The overriding issue in that race, too, is healthcare.
It is not just congressional action that has Republicans playing defense around the ACA. In February, 18 GOP attorneys general and 2 GOP governors filed a lawsuit seeking a judgment the law is now unconstitutional because Congress within the 2021 goverment tax bill repealed the penalty for not having insurance. Two of those attorneys general – Missouri's Josh Hawley and West Virginia's Patrick Morrisey – are running for the Senate. Both states overwhelmingly supported President Mr . trump in 2021.
The attorneys general are running against Democratic incumbents – Claire McCaskill of Missouri and Joe Manchin of West Virginia. And both Republicans are being hotly criticized by their opponents for his or her participation in the lawsuit.
Although Manchin appears to have taken a lead, the Hawley-McCaskill race is rated a toss-up by political analysts.
But in the end the fate of the ACA depends less on an individual race than you are on which party winds up in control of Congress.
“If Democrats take the House – then any attempt for repeal-and-replace will be kaput,” said John McDonough, an old Democratic Senate aide who helped write the ACA and today teaches in the Harvard School of Public Health.
Conservative healthcare strategist Chris Jacobs, who helped Republicans on Capitol Hill, said a brand new repeal-and-replace effort might not happen even if Republicans are successful Tuesday.
“Republicans, when they maintain the majority in the House, have a margin of the half dozen seats – if they are lucky,” he said. That likely would not permit the party to proceed another controversial effort to alter the law. Currently there are 42 more Republicans than Democrats in the House. Even so, the GOP barely got its health bill passed out of the House in 2021.
And political strategists state that, when the dust clears after voting, the numbers in the Senate may not be much different so change could be hard there too. Republicans, despite a little majority this past year, could not pass a repeal bill there.
2. Medicaid expansion
The Supreme Court in 2012 made optional the ACA's expansion of Medicaid to cover all low-income Americans up to 138 percent from the poverty line ($16,753 for an individual in 2021). Most states have now expanded, particularly because the federal government is paying the majority of the price: 94 percent in 2021, gradually dropping to 90 percent in 2021.
Still, 17 states, all with GOP governors or state legislatures (or both), have yet to expand Medicaid.
McDonough is confident that's about to change. “I'm wondering if we're around the cusp of the Medicaid wave,” he said.
Four states – Nebraska, Idaho, Utah and Montana – have Medicaid expansion questions on their ballots. Basically Montana haven't yet expand the program. Montana's question would eliminate the 2021 sunset date included in its expansion in 2021. However it is going to be interesting to look at results because the measure has run into big-pocketed opposition: the tobacco industry. The initiative would increase taxes on cigarettes along with other cigarettes and tobacco products to finance the state's increased Medicaid costs.
In Idaho, the ballot is through being embraced by a number of Republican leaders. GOP Gov. Butch Otter, who is retiring after three terms, endorsed it Tuesday.
But the issue is in play in other states, too. Several non-expansion states have close or closer-than-expected races for governor in which the Democrat has made Medicaid expansion important.
In Florida, one of the largest states to not have expanded Medicaid, the Republican candidate for governor, former U.S. Rep. Ron DeSantis, opposes expansion. His Democratic opponent, Tallahassee Mayor Andrew Gillum, supports it.
In Georgia, the gubernatorial candidates, Democrat Stacey Abrams and Republican Brian Kemp, are also on opposite sides from the Medicaid expansion debate.
However, the legislatures in both states have opposed the development, and it is unclear if they could be swayed by arguments from the new governor.
Until recently, Republicans have remained relatively quiet about efforts to alter the popular Medicare program for seniors and individuals with disabilities.
Their new talking point is the fact that proposals to grow the program – like the often touted “Medicare-for-all,” which an increasing number of Democrats are embracing – could threaten the existing program.
“Medicare is at significant risk of being cut if Democrats take over the House,” Rep. Greg Gianforte (R-Mont.) told the Lee Montana Newspapers. “Medicare-for-all is Medicare for none. It will gut Medicare, end the VA as we know it, and force Montana seniors towards the back of the line.”
Gianforte's Democratic opponent, Kathleen Williams, is proposing another idea well-liked by Democrats: allowing people age 55 and also over to “buy into” Medicare coverage. That race, too, is extremely tight.
Meanwhile, in Washington, congressional Republicans are more worried about how Medicare along with other large government social programs are threatening the budget.
“Sooner or later we will exhaust other's money,” said Chris Jacobs.
Senate Majority Leader Mitch McConnell suggested within an Oct. 16 interview with Bloomberg News that entitlement programs like Medicare are “the real driver from the debt by objective standard,” but that bipartisan cooperation will be needed to address that problem
Republican Jacobs and Democrat McDonough think that's unlikely in the near future.
“Why would Democrats give that as an issue heading into 2021?” asked McDonough, especially because Republicans in recent years happen to be proposing deep cuts to the Medicare program.
Agreed Jacobs, “Trump might not want that to become the centerpiece of a re-election campaign.”