Three takeaways for health care from the federal elections

Whether you believe it was a “blue wave” or not, the makeup of federal government changed last night in some key ways. The Democrats took back the house. The Republicans solidified their hold on the Senate. What does this mean for health care? Here are some key takeaways as we move forward.

  • The ACA itself is no longer the primary fight.

Given the numerical deadlock at the federal level, “Repeal and Replace” is no longer on the plate but that does not mean that the Act’s contents are no longer in jeopardy. Health care was a major issue for both parties this election season and will likely continue to be, but there simply are not the votes to move a large-scale legislative initiative. Less contentious issues may be able to gather bi-partisan support, like the CREATES Act aimed at reforming drug pricing.

  • Watch the regulations.

With deadlock likely on the legislative side, movement on health care policy may come through the Executive and Judicial branches through new regulations, executive actions, and court decisions. Though Congressional actions grab the headlines, laws are applied, interpreted, and implemented through regulations and judicial decisions, and here the administration has considerable power. Recent regulations have included changes to risk sharing, extending the definition of short-term health insurance, and relaxing the definition of what must be included in ACA plans as “essential benefits,”  all of which have changed the landscape of the ACA, while the Justice Department’s decisions on what cases to pursue or not, could also have lasting implications for the Act. Check the CMS website here for information on new proposals and comment periods that may not receive mainstream coverage, but may nonetheless affect industry interests.

  • Look for states to move to the lead.

As we watch for the federal government to move policy by regulation, or deregulation as the case may be, state influence over the direction of health care policy has room to increase. Thirty seven states have currently adopted Medicaid expansion through waivers designed to give states flexibility to innovate new models of care coordination and provision. Several states, including California, Hawaii, Oregon, and Washington, have moved to prohibit or limit short-term insurance plans.  Some state have sought to stabilize the individual markets by instituting reinsurance programs, and a coalition of sixteen states are defending the ACA in the federal lawsuit challenging its constitutionality.