Health policy was on the ballot in several states
With the winner of the presidency and party control of the Senate still unclear the morning after Election Day, the future of the nation's health system remains uncertain. At stake is whether the federal government will play a stronger role in financing and setting the ground rules for health care coverage or cede more authority to states and the private sector.
Should President Donald Trump win and Republicans retain control of the Senate, Trump still may not be able to make sweeping changes through legislation as long as the House is still controlled by Democrats. But — thanks to rules set up by the Senate GOP — the ability to continue to stack the federal courts with conservative jurists who are likely to uphold Trump's expansive use of e xe cutive power could effectively re make the government' s relationship with the health care system even without signed legislation.
The president has also pledged to continue his efforts to get rid of the Affordable Care Act, and if the Supreme Court overturns the sweeping law as part of a challenge it will hear next week, the Republicans' promise to protect people with preexisting medical conditions will be put to the test. In a second term, the administration would also likely push to continue to revamp Medicaid with its efforts to institute work requirements for adult enrollees and provide more flexibility for states to change the contours of the program.
If former Vice President Joe Biden wins and Democrats gain a Senate majority, it would represent the first time the party has controlled the White House and both houses of Congress since 2010 — the year the ACA was passed. A top priority will be dealing with the COVID-19 pandemic and the economic fall out. Biden made that a keystone of his campaign, promising to implement policies based on advice from medical and scientific advisers and provide
more directives and aid to the states.
But also high on his agenda will be addressing parts of the ACA that haven't worked as well as its authors hoped. He pledged to add a gover nm en t-run“public option ,” which would be an alternative to private insurance plans on the marketplaces, and to lower the eligibility age for Medicare to 60.
While Democrats will continue to control the House, the final makeup of the Senate is still to be determined. And even if the Democrats win the Senate, they are not expected to come away with a majority that would allow them to pass legislation without support from at least some GOP senators, unless they change the Senate's rules. That could lower expectations of what t he Democrats can accomplish—and may lead to some tensions among members.
But who controls Washington, D. C ., is only part of the election's impact on health policy. Several key health issues were on the ballot both directly and indirectly in many states. Here are a few:
Abortion
In Colorado, a measure that would have banned abortions after 22 weeks of pregnancy — except to save the life of the pregnant person — failed, according to The Associated Press. Colorado is among seven states that don't prohibit abortions at some point in pregnancy. It is also home to one of the few clinics in the nation that perform abortions in the third trimester, often for severe medical complications. The clinic draws patients from around the nation, so residents of other states would have been affected if the Colorado amendment passed.
In Louisiana, however, voters easily approved an amendment to the state constitution to say that nothing in the document protects the right to, or requires the funding of, abortion. That would make it easier for the state to outlaw abortion if the Supreme Court overturns Roe v. Wade, which makes state abortion bans unconstitutional.
Medicaid
The fate of the Medicaid program for people with low incomes is not on the ballot directly anywhere t his election. (Voters approved expansions of the program in Missouri and Oklahoma earlier this year.) But the program will be affected not only by who controls the presidency and Congress, but also by who controls the legislatures in states that have not expanded the program under the Affordable Care Act. North Carolina is a key swing state where a change in majority in the legislature could turn the expansion tide.