What the 2018 midterm elections mean for healthcare: predictability

In a report issued Wednesday, PwC said a split Congress means major overhauls—such as either a Republican-led repeal and replace or a Democrat-led move to single payer—are off the table in the short term. (Getty/jdwfoto)

Democrats may not have ridden a blue wave as big as the one they hoped for, but the party's reclamation of the House majority for the first time in eight years has a major implication for the healthcare industry: predictability. 

In a report issued Wednesday, PwC said a split Congress means major overhauls—such as either a Republican-led repeal and replace or a Democrat-led move to single payer—are off the table in the short term. 

Benjamin Isgur, Health Research Institute leader at PwC, told FierceHealthcare providers are likely breathing a sigh of relief, because they’re already “knee deep” in investments in IT, value-based models and other delivery system reforms. 

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“You can start your two-to-five-year planning process, and there’s not a big question mark that is: ‘What does the health system look like?’” Isgur said.

RELATED: Democrats take the House, giving the ACA a safety net for now 

PwC outlined several other key trends, including: 

  • The rising cost of healthcare. Isgur said the industry will still need to reckon with healthcare’s growing share of the economy regardless of who is in office.
     
  • More impactful changes at the state level. A split Congress isn’t going to be passing major healthcare legislation in the next two years. But at the state level, new Medicaid expansion rollouts and other policy changes will be bigger.
     
  • Democrats meddling in administration policies. Oversight power in the House means that Democrat-led committees can play more of a role in blocking actions taken by health officials in the Trump administration, such as work requirements for Medicaid expansion populations. 
     
  • Lowering drug prices as a bipartisan bright spot. Both parties and the administration are interested in making strides in this area, the report said. 

Democrats are likely to wield their new oversight power to work with the administration on drug-pricing issues, such as transparency and enhancing negotiating power in Medicare Part D, said Rachel Stauffer, a director at McDermott+Consulting, the consultant subsidiary of the McDermott, Will & Emery law firm.

One piece of much-talked-about policy that’s likely to move to the back burner, however, is the 340B drug discount program, she said.  “There is a lack of consensus, even among the parties, about 340B policy,” Stauffer said. 

RELATED: Infrastructure, committee changes are health IT focal points as congressional dynamics shift 

Shifting committee roles in the Senate, even as Republicans remain in control, could play a role in the ongoing drug price debate, she said. Sen. Chuck Grassley, R-Iowa, could take over a chair of the Finance Committee following Orrin Hatch’s retirement, and he’s shown an interest in taking pharmaceutical companies to task on high prices. 

A split Congress is also likely to stay interested in hot-button topics like the opioid epidemic, Stauffer said. 

Despite these implications, the outcome of the midterms doesn’t necessarily offer a valuable litmus test on the trajectory of health policy in the short or long term, Michael Abrams, co-founder and managing partner of Numerof & Associates, told FierceHealthcare. 

For example, Democrats in favor of a single-payer healthcare system won in some cases and lost in others, Abrams said. And several states opting into Medicaid expansion doesn’t end that debate nationwide, either. 

Abrams said the Department of Health and Human Services is clearly dedicated to pushing the industry toward a more market-based model, and even with increased Democrat oversight, they’re not likely to be completely derailed in that goal.  

Echoing PwC, Abrams said the industry will need to face macroeconomic challenges regardless of the election outcome.

“I think drawing generalized conclusions about any of that is not productive and it detracts from the bigger picture: We’re running out of money,” Abrams said.