What a divided Congress could mean for healthcare in the next year

As voters head to the polls, several prognosticators believe Republicans have a solid chance of flipping control of the House, with the race for the Senate a toss-up.

Such a change could bring some major shifts in healthcare policy. In the current Congress, Democrats were able to expand Affordable Care Act (ACA) subsidies and introduce drug price reforms, but experts say there could still be some progress on areas of common ground if Republicans take one or both chambers of Congress.

With President Joe Biden still in the White House, Republicans could primarily use their new majority to hold oversight hearings. 

“If Republicans win control of the House or the Senate, expect gridlock, lots of executive actions by President Biden to advance his agenda without Congress, and lots of congressional oversight hearings,” tweeted Larry Levitt, executive vice president for health policy for the Kaiser Family Foundation. 

Republicans could use their oversight tools to scrutinize the implementation of the Inflation Reduction Act that gave Medicare the power to negotiate for lower drug prices for a small subset of Medicare Part B drugs, said Joel White, CEO of consulting firm Horizon Government Affairs and a former hill staffer.

“This is a sea change in how drug pricing works in America,” White said in an interview with Fierce Healthcare. “The law basically says for four years you get to do this without issuing formal regulations.”

There could be some areas of common ground Republicans could find with Democrats, especially in areas like telehealth. A bill to extend telehealth flexibilities for Medicare beneficiaries through December 2024 overwhelmingly passed the House and awaits consideration in the Senate. 

White added that Republicans are likely to look at affordability and coverage issues, especially in the small group market, as small businesses have been hit hard by the pandemic and inflation.

Abortion rights on the ballot

The Supreme Court’s decision to strike down Roe v. Wade this past summer shifted the abortion issue to the states, and several are expected to decide its legality in ballot initiatives Tuesday. 

Voters in California, Vermont, Montana, Kentucky and Michigan are going to decide on ballot measures surrounding a constitutional right to abortion. Kansas had a ballot vote earlier this year and overwhelmingly voted in favor of abortion rights.

Currently, there are 22 states that have laws that restrict abortions and there are 16, as well as the District of Columbia, that protect such rights, according to the pro-choice think tank Guttmacher Institute. 

The ballot measure votes come as some providers remain confused about how to deliver emergency care in states with no exceptions to abortion. 

The Department of Health and Human Services released a guidance after the Dobbs v. Jackson Women's Health Organization ruling that said providers must offer abortion as emergency care even if it counteracts a state law banning the practice. That guidance sparked a lawsuit from Texas over whether the agency had the authority to circumvent the state’s ban. 

Another ballot measure to look for is in South Dakota, where voters will decide whether to expand Medicaid under the ACA. Ballot measures have become a popular method for advocates to get Medicaid expanded in red states in recent years.