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How the ‘red ripple’ could impact health policy in 2023 and beyond

Rather than a red ripple, the 2022 Congressional midterms brought a “red ripple.”

With the races still decided and the votes counted, the Democrats took control of the Senate, despite a runoff in Georgia. It looks like Republicans will retake the House – albeit with a much smaller majority than they had hoped.

What does all this mean for health policy? With a divided Congress, President Biden’s ability to pass major, sweeping legislation along party lines (like the Cut Inflation Act) falls by the wayside. But this does not mean that the legislation stops. Contrary to popular opinion, Congress has passed important health-related legislation with bipartisan support in recent years. This includes:

Even the ObamaCare lightning rod issue, which once saturated campaign debates, has lost some of its polarizing energy. This cycle, we’ve seen the red state of South Dakota approve a ballot measure to expand the state’s Medicaid program under the Affordable Care Act, opening coverage to more than 40,000 additional residents.

Assuming a divided legislature, here are five areas where we could see health action in the 118th Congress:

  1. Maternal and child health: The United States faces a maternal mortality crisis, with a recent report from the Centers for Disease Control and Prevention finding that 4 out of 5 pregnancy-related deaths in the United States are preventable. Maternal health is increasingly an issue as access to abortion has changed following the Dobbs decision;
  2. Telehealth: regulatory flexibilities allowed during the COVID-19 public health emergency are about to expire, and there is bipartisan interest in extending these regulatory changes;
  3. 21st Century Cures 2.0 – building on the 2016 bipartisan version of this legislation, it has broad congressional support, as well as support from key industry stakeholders and national medical organizations;
  4. Medicare provider payment: Providers want to see Medicare payment reform, with many still struggling financially due to the pandemic, and now with inflation and rising skyrocketing labor costs;
  5. Mental Health: COVID-19 has exacerbated the nation’s mental health crisis, and lawmakers on both sides are interested in providing additional mental health and addictions coverage, support, and resources.

With the expected GOP scrutiny in the House, there will also be a noticeable increase in government scrutiny. House Republican leaders have already expressed a desire to investigate Hunter Biden’s business dealings with the Biden administration’s withdrawal from Afghanistan, but there could also be health-related investigations. Criticism of President Biden’s federal COVID-19 response, as well as the CDC and National Institutes of Health response, could be investigated, with some GOP leaders calling for a subpoena for the outgoing director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci. And the use of the $1.9 trillion COVID relief legislation signed early in Biden’s presidency could also come under scrutiny for unnecessary spending.

While Congress is undoubtedly more polarized than my term, there are health issues on which we will continue to bridge the gap. Rising health care costs will persist as a major issue affecting Americans. Unpaid medical bills are the biggest source of debt in America and the number one cause of bankruptcy. A recent McKinsey report found that spikes in labor costs and rising procurement costs due to inflation are now being borne by suppliers, but in coming years they will ripple through employers and consumers, predicting a $370 billion increase in US healthcare spending by 2027.

Voters will feel this pinch and their elected leaders will want to show they are acting on it.

Bill Frist, MD is a heart and lung transplant surgeon, senior fellow at the Bipartisan Policy Center, and chair of the World Council of The Nature Conservancy. He represented Tennessee in the U.S. Senate for 12 years and served as Senate Majority Leader from 2003 to 2007.

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