With an exciting midterm election now on the books, we wanted to take a moment to wrap up some of last week’s election results and what they could mean for people with diabetes, diabetes educators, and the healthcare system as a whole.
Democrats Take the House
One of the biggest headlines from election night was Democrats’ newly formed majority in the House of Representatives. Minority Leader Nancy Pelosi (D-CA) will likely become the next Speaker of the House. Pelosi was a key champion in passing the Affordable Care Act in 2010 making it unlikely that any repeal efforts will get to the House floor in the upcoming congress, as the Speaker decides which legislation ultimately comes up for a vote. Democrats are also unlikely to move any legislation cutting Medicare benefits. In a press conference following the election, President Trump said that he hopes to collaborate with the Democratic majority on issues of common concern, including the stabilization of drug prices.
Current House Speaker Paul Ryan’s (R-WI) retirement opens up opportunities for House Republican leadership. Reps. Kevin McCarthy (R-CA) and Rep. Jim Jordan (R-OH) have already announced their intentions to run for House Minority Leader.
Republicans Make Gains in Senate
Republicans gained at least three seats in the Senate, defeating vulnerable Democrats Claire McCaskill (MO), Heidi Heitkamp (ND), and Joe Donnelly (IN). At this time, the races in Arizona and Florida still appear too close to call and ballots are still being counted in those states. Democrats won a seat in Nevada where (current House Rep.) Jackie Rosen defeated incumbent Dean Heller. Republicans currently hold 51 confirmed seats and may end up with as many as 54 seats once all the votes are counted. Democrats hold 46 confirmed seats (counting two Independents who caucus with the Democrats).
Medicaid on the Ballot
The Affordable Care Act expanded Medicaid coverage for Americans who earn less than 133 percent of the federal poverty line (about $16,000 for an individual or $33,000 for a family of four) with one caveat: states have to opt-in to receiving federal funds for the expansion.
Thirty-four states (including DC) have chosen to accept federal funding for Medicaid expansion. In 2017, Maine became the first state to expand Medicaid thought a state-wide ballot initiative. On election night, three more states: Idaho, Nebraska, and Utah followed suit, voting to give an estimated 325,000 people access to coverage.
Conversely, voters in Montana voted to end the state’s Medicaid expansion- rejecting a ballot initiative that proposed extending the program beyond June 2019 while also raising state cigarette taxes. Part of the estimated additional $72-74 million in tax revenue from the cigarette tax would have funded the continuation of Medicaid expansion in the state. Since the state first accepted the expansion in 2015, 129,000 Montanans have gained coverage that is unlikely to continue past the end of the year. All eyes are now on the Montana legislature to determine the fate of Medicaid expansion.
State Level Election Results
Kansas, a state which has not yet expanded Medicaid, elected Democrat Laura Kelly to be its next governor. In the past, expansion bills have passed the legislature, only to be vetoed by Republican Governor Sam Brownback. With a new administration in place, the state may finally approve Medicaid expansion.
We may also see healthcare changes in California, where Governor-elect Gavin Newsom campaigned on a platform of bringing single-payer healthcare to the Golden State.
Republicans retained governorships in several states that will be key in the 2020 presidential election. Mike DeWine (R-OH) will succeed John Kasich, who could not stand for re-election due to term limits.
The Florida governor’s race between Andrew Gillum (D) and Ron DeSantis (R) may be forced in to an automatic re-count. Additionally, the high-profile race in Georgia between Stacy Abrams (D) and Brian Kemp (R) may be forced into a run-off election in December. In both states, the Republican is likely to come out the victor.
A Lame-Duck Congress: What Happens Now?
Congress is set to return on November 13, 2018 to begin the lame-duck session. We anticipate they will pass an appropriations bill to keep much of the government funded. We also expect that Congress will reconcile differences in the House and Senate “Farm Bills” which includes funding for the Supplemental Nutrition Assistance Program (SNAP) formerly known as “food stamps.”. There may be the addition of work requirements for those receiving SNAP benefits. Congress may also pass a package of corrections to the 2017 tax law.
Given the limited left in the Congress, and some of the other pressing priorities, AADE does not anticipate that its federal legislation, the Expanding Access to DSMT Act (H.R.5768; S.3366) will pass during the lame-duck session, yet we have been working to lay the groundwork for re-introduction and passage in the 116thCongress.
AADE representatives, along with members of the Diabetes Advocacy Alliance (DAA), have been actively meeting with congressional offices to discuss the benefits of DSMT and how this bill would help seniors with diabetes have better access to the service. AADE members have also been writing to, meeting with, and contacting their members of Congress to help garner support for this legislation. If you haven’t already done so, please visit AADE’s Legislative Action Center and send a letter to your congressional representatives urging them to support the bill. We appreciate the support of AADE members in building the momentum to advance this legislation.
What’s Next in Congress for 2019?
With divided political control of congress and many lawmakers setting their sights on the 2020 presidential election, we are not expecting the passage of sweeping legislation. However, healthcare issues are expected to remain a central focus in congress. Here are a few possible policy changes to watch for:
- Requiring drug manufacturers to disclose list prices in TV advertisements;
- Mandating greater transparency in drug manufacturer and pharmacy benefit manager relationships;
- Increasing Medicaid penalties on drug manufacturers that increase list prices above the inflation rate; and
- Preventing brand drug companies from utilizing Food and Drug safety programs to block cheaper generic drug competition.
One final programming note: Join AADE for an Advocacy Webinar on December 4
Representatives from AADE’s Washington, DC-based consulting firm, Baker Donelson, will be the featured speakers for a webinar on December 4 from 1:00-2:00pm Eastern entitled “Washington Policy Recap and Look Ahead to the 116th Congress.” This webinar will provide a policy overview of what’s currently happening in Washington and what to expect as the new congressional session takes shape. The webinar will focus on the status of the Expanding Access to DSMT Act (H.R. 5768, S. 3366) and how we are already laying the groundwork for the upcoming congressional session. Click here to register.