A new Congress hears a delayed State of the Union

  

After a postponement following the partial government shutdown, President Trump’s State of the Union address to the newly elected 116th Congress included outlining his vision to end the HIV/AIDS epidemic by the end of the next decade and pledging $500 million over 10 years to fight childhood cancer, the leading disease-related cause of death in American children.

The President also touted recent declines in prescription drug prices and promised additional reductions, while maintaining that he supported coverage for pre-existing conditions. It is politically feasible that the Democratic-controlled House and Republican-controlled Senate could find common ground with the President on both the HIV/AIDS and childhood cancer efforts.

Lowering prescription drug prices is something both President Trump and House Speaker Nancy Pelosi listed as a priority when they gave their respective news conferences post-Election Day. However, lawmakers from both parties have spent years trying to address this issue, with limited success. It remains to be seen whether the Democratic House and Republican Senate can come together in collaboration with the White House to craft an effective piece of legislation in the face of what is likely to be intense lobbying from pharmaceutical companies and other health industry stakeholders.

In the official Democratic response former Georgia gubernatorial candidate and state representative Stacey Abrams called on leaders in Washington to tackle the ongoing issue of gun violence prevention and criticized Republican Attorneys General who have joined a Texas court case that would invalidate the entire Affordable Care Act (ACA). She urged elected officials to back efforts that would expand access and lower the cost of health care. Abrams also joined the President in pointing out that prescription drugs are too expensive for too many families, and that policy solutions are badly needed to address this.

While health care is unlikely to dominate the start of this Congress to the extent that it dominated the start of the previous Congress, lawmakers on both sides of the aisle still believe that voters sent them to Washington to take tangible steps toward improving the American health care system. Despite the challenges of divided government, the prominence of health policy in the SOTU and the Democratic rebuttal emphatically shows that your vote truly matters when it comes to policy decisions regarding the nation’s health care system.

An unexpected health care ruling leads to turmoil

  

Friday night’s ruling by a federal district judge in Texas v. Azar that the Affordable Care Act (ACA) is unconstitutional has created fresh uncertainty in the U.S. health care system. While the ruling does not immediately impact the health law itself, it could potentially upend the American health care system in significant ways.

Members of Congress on both sides of the aisle immediately vowed to take steps that would retain the ACA’s protections for patients with pre-existing conditions and Essential Health Benefits (EHB) while the case continues to make its way through the legal system (experts widely believe that Friday’s decision will be appealed to the Fifth Circuit Court of Appeals and could ultimately reach the Supreme Court).

ANA’s official statement noted that “This ruling puts at risk access to quality, affordable, and accessible health care for the millions of Americans whose lives have improved due to the coverage expansions and consumer protections under the ACA.”

Incoming Senate Finance Committee Chairman Chuck Grassley (R-IA) promised on Twitter that his committee would hold hearings on the ruling, and that he would work with Democrats to “strengthen” the ACA through legislation, while Sen. Susan Collins (R-ME) said she was sure the ruling would be overturned and that “There is widespread support for protecting people with preexisting conditions.”

Senate Minority Leader Chuck Schumer (D-NY) vowed to press for a vote on the Senate floor “urging an intervention in the case,” and House Minority Leader Nancy Pelosi (D-CA), widely expected to lead Democrats as Speaker in the 116th Congress, pledged to “move swiftly to formally intervene in the appeals process.”

President Trump indicated via Twitter that a potential Supreme Court ruling that upheld Friday’s decision would offer an opportunity to work in a bipartisan fashion “to deliver great health care.” He called on lawmakers to formulate and pass a replacement for the ACA, despite the limited success of previous efforts to do so.

Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), was quick to clarify via social media that the ruling would not adversely impact consumers who were still shopping for individual health insurance coverage during the Open Enrollment period that ended on Saturday, December 15th. In a formal statement, the Department of Health and Human Services (HHS) echoed this point, noting that “This decision does not require that HHS make any changes to any of the ACA programs it administers or its enforcement of any portion of the ACA at this time.”

The Texas v. Azar lawsuit was brought following the congressional repeal of the individual mandate in December 2017 as part of the Tax Cuts and Jobs Act. The Texas Attorney General, along with AGs in 19 other states, argued that this repeal eliminated the Supreme Court’s rationale for finding the individual mandate constitutional in the 2012 Supreme Court decision NFIB v. Sebelius. Though driven by these states, the focus will now shift to Congress, following an election cycle in which support for major provisions of the Affordable Care Act and health care in general were key campaign issues.

A historic midterm delivers a complicated path forward on health care

  

An extraordinary 114 million voters cast ballots Tuesday and delivered the House of Representatives back into the hands of the Democratic party, while voters in more conservative states chose to oust several Democratic incumbents to ensure that the Senate remains under Republican control for the 116th Congress. While some races have yet to be called, turnout was the highest it’s ever been for a midterm election, and the outcomes ensure that lawmakers will have to find a way to reach bipartisan consensus to achieve any meaningful health policy outcomes before the next national election in 2020.

In the Illinois 14th congressional district, registered nurse Lauren Underwood successfully unseated her incumbent opponent, ensuring that the 116th Congress will benefit from the perspective and insights of a member of America’s most trusted profession. Endorsed by ANA-PAC, Underwood focused her campaign messaging on the need to improve health policy and is likely to make it a major component of her agenda once in office.

Similarly, Democratic candidates across the country put health care at the center of their campaigns, and the new House majority is widely expected to tackle issues like market stabilization once the 116th Congress convenes, as well as other measures to shore up the Affordable Care Act (ACA). As with all issues in the new Congress, getting a bill on the President’s desk for signature will require bipartisan cooperation with Sen. Mitch McConnell (R-KY) and his now expanded majority.

Despite uncertainty around how fruitful any such cooperation might be, divided control of Congress ensures that any subsequent attempts to repeal and/or replace additional elements of the ACA will be dead on arrival, particularly given the prominence of protecting patients with pre-existing conditions in Democratic campaign messaging. House Democrats will also likely consider legislation to bring back the ACA’s mandate that individuals attain health coverage, which was eliminated in the tax package congressional Republicans passed late last year.

While more progressive candidates tended to focus on the need for a single-payer health care system, most commonly referred to as Medicare for All, this approach will be a non-starter in the Republican Senate, increasing the likelihood that more incremental reforms will be the focus on Capitol Hill. Despite this, single-payer proponents will continue to push both incumbent lawmakers and those who challenge them on the left to embrace Medicare for All, in the hopes of eventually electing a Congress that can pass it.

In post-election press conferences, both President Donald Trump and current Democratic Minority Leader Nancy Pelosi (who is widely expected to attempt to regain the title Speaker of the House) indicated that they would seek to find common ground on a number of issues, including legislation that would reduce prescription drug costs, though details on how to accomplish this shared goal are unclear.

On the ballot initiative front, three states voted to do what their governors and state lawmakers had so far refused to do: expand access to Medicaid. Voters in Idaho, Nebraska, and Utah all approved measures to allow adults and their families to receive coverage via this federal program. States will now be required to submit a State Plan Amendment that outlines how they will implement these programs, with deadlines arriving either in early March or April of next year, depending on the state. Other states that have held off on Medicaid expansion are likely to consider similar initiatives going forward.