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2018 ELECTIONS: MIDTERMS SHOW HEALTHCARE NOT AN OVER POWERING WAVE

 

By Julie Rovner

Healthcare proved important but apparently not pivotal in the 2018 ELECTIONS

on Nov. 6  as voters gave Democrats control of the U.S. House, left Republicans in charge in the Senate and appeared to order an expansion of Medicaid in at least three states long-controlled by Republicans.

In taking over the House, Democrats are unlikely to be able to advance many initiatives when it comes to health policy, given the GOP’s control of the Senate and White House. But they will be able to deliver an effective veto to Republican efforts to repeal the Affordable Care Act, convert the Medicaid healthcare system for low-income people into a block grant program and make major changes to Medicare.

One likely development is an expansion of Medicaid in several of the 18 states that had so far not offered coverage made available by the Affordable Care Act. Voters in Idaho and Nebraska easily approved ballot measures calling for expansion. A similar measure was leading in Utah based on incomplete returns.

            In Montana, voters are deciding if the existing expansion should be continued and the state’s expenses covered by raising tobacco taxes. In preliminary results, opponents outnumbered supporters.

Medicaid might also be expanded in Kansas, where Democratic gubernatorial candidate Laura Kelly defeated GOP Secretary of State Kris Kobach. The Kansas legislature had previously passed Medicaid expansion, but it was vetoed in 2017 by former GOP Gov. Sam Brownback. Kobach had not supported the ACA expansion.

And in Maine, where voters approved Medicaid expansion in 2017 but GOP Gov. Paul LePage refused to implement it, Democrat Janet Mills was victorious. She has promised to follow the voters’ wishes. LePage was not running.

The abortion issue was also on the ballot in several states. In Alabama and West Virginia, voters approved state constitutional amendments that would make it easier for the states to ban abortion entirely if the Supreme Court were to overturn Roe v. Wade. Oregon voters, on the other hand, defeated a measure that would have restricted public funding of abortion and insurance coverage for abortion.

The mixed results allowed both sides of the polarized abortion debate to claim victory.

“This election is a major victory … for everyone in this country who cares about access to healthcare and access to reproductive health care,” Deirdre Schifeling, executive director of Planned Parenthood Votes, told reporters in a conference call.

Said Marjorie Dannenfelser, president of the anti-abortion Susan B. Anthony List: “Yesterday was a clear victory for the pro-life movement. The Senate once again has a pro-life majority — a ringing affirmation of President Trump’s pro-life agenda from the American people, who have seen him deliver on a key promise by appointing two outstanding Supreme Court justices.”

In exit polling, as in many earlier surveys in 2018, voters said that healthcare, particularly preserving protections for people with preexisting conditions, was their top issue. But healthcare remained more important to Democrats than to Republicans.

Those who urged Democrats to emphasize healthcare this year took credit for the congressional successes. “The race for the House was a referendum on the Republican war on healthcare. You know it, I know it, and the Republican incumbents who shamefully tried to cover up their real record on healthcare and lost their seats know it,” said Brad Woodhouse of the advocacy group Protect Our Care.

But the issue was not enough to save some of the Senate Democrats in states won by President Donald Trump in 2016. Sen. Claire McCaskill (D-Mo.) was defeated by GOP Attorney General Josh Hawley, who is a plaintiff in a key lawsuit seeking to declare the Affordable Care Act unconstitutional. Sens. Heidi Heitkamp (D-N.D.) and Joe Donnelly (D-Ind.), who also campaigned hard on healthcare, were defeated.

Nonetheless, Sen. Joe Manchin (D-W.Va.) beat Republican Patrick Morrisey, the state’s attorney general who is also a plaintiff in the lawsuit seeking to upend the ACA.

Rep. Nancy Pelosi (D-Calif.), the leader of the House Democrats who would be first in line to take over as speaker, told supporters gathered in Washington for a victory celebration that her caucus would make healthcare a key legislative issue.

“It’s about stopping the GOP and [Senate Majority Leader] Mitch McConnell’s assault on Medicare, Medicaid and the Affordable Care Act and the healthcare of 130 million Americans living with preexisting medical conditions,” she said. She pledged that Democrats would take “very, very strong legislative action” to lower the cost of prescription drugs.

In a wide-ranging news conference the day after the election, Trump struck something of a conciliatory tone toward the new Democratic majority in the House.

“I believe Nancy Pelosi and I can work together to get a lot of things done,” Trump said. “I suspect [House Democrats] will come up with some fantastic ideas that I can support … including prescription drug prices.”

Among the many new faces in the House is at least one with some significant experience in health policy. Former Health and Human Services Secretary Donna Shalala, who ran the department for all eight years of the Clinton administration, won an open seat in Florida. VTN

 

Julie Rovner, the Robin Toner Distinguished Fellow, is chief Washington correspondent for the Kaiser Health News. She joined KHN after 16 years as health policy correspondent for NPR, where she helped lead the network’s coverage of the passage and implementation of the Affordable Care Act. A noted expert on health policy issues, she is the author of the critically praised reference book Health Care Politics and Policy A-Z, now in its third edition. In 2005, she was awarded the National Press Foundation’s Everett McKinley Dirksen Award for distinguished reporting of Congress. Prior to NPR, Julie covered health policy for National Journal’s Congress Daily and for Congressional Quarterly, among other organizations.

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Larry Storer

Larry Storer

Larry Storer has been editor of Vein Therapy News for 10 years. He has edited computer, shelter and medical publications at Publications & Communications LP for 30 years. He was also a corporate vice president and editorial director before retiring. Larry graduated from Baylor University with a BA in journalism and an MA in communications; and from Lamar University with a MED in school administration. He taught beginning and advanced reporting, beginning and advanced editing and editorial writing at Baylor University. Larry was a reporter, and city and news editor of the Beaumont Journal, and opinion editor at the Beaumont Enterprise and Beaumont Enterprise-Journal. He was also the founding managing editor of the Yuba City (California) Daily Independent-Herald.