Top policy experts brief reporters on what this election means for health care

Published on
November 9, 2018

In the aftermath of the midterms and the Democrats' newly secured majority in the House of Representatives, a Center for Health Journalism webinar asked two leading experts for their take on what the results mean for the country’s health care policies.

“Tuesday’s election was an indication of where things are headed in terms of how the American public views health care,” said Lanhee J. Chen, the David and Diane Steffy Research Fellow at the Hoover Institution and director of domestic policy studies at Stanford. “A great number of Americans believe that the federal government should play an active role in the health care system.”

While there’s still not consensus that the government should be involved in all aspects of health care, the elections signified some agreement on the value of government regulations that protect consumers with pre-existing health conditions, said Chen, who has advised four presidential campaigns including the 2012 Romney-Ryan campaign.

On the other side of the political aisle, attendees heard from Jeanne Lambrew, a senior fellow at The Century Foundation and an adjunct professor at the NYU Wagner Graduate School of Public Service. Previously, she served in the Obama administration as the director of the Office of Health Reform at the U.S. Department of Health and Human Services, where she helped coordinate the passage and implementation of the Affordable Care Act.

Republicans have to act

Health care has only gotten more complicated for Republicans since the period of “repeal and replace,” Chen said. The question for Republicans now, in an era of divided control of the legislature, is whether to revisit health care at all.

“My view is that it’s inevitable,” he said.

If Republicans don’t pursue new legislative fixes, they’ll be left with the unsatisfactory aftermath of the repeal-and-replace effort.  “They certainly cannot leave health care exactly as it is now,” he said. “Politically … that would be perilous not just for Republicans in Congress but President Trump as well.”

While there could be some bipartisan support on issues such as prescription drug pricing, it’s clear that Democrats and Republicans still feel very differently about the ACA, he said. One option for Republicans is to pursue state-level changes to the ACA through waivers. Even if these efforts don’t succeed, they could still create a useful platform for the 2020 campaign. 

Democrats see openings

Lambrew agreed the debate over health care will continue into the 2020 presidential election. While Republicans may focus on state-level administrative changes, Democrats are emphasizing the critical role they believe government must play in health care, she said.

Meanwhile, Lambrew said the new Congress — with many new members who are energized about health care — could lead to “concrete change.”

Lambrew also pointed to the Texas v. United States, an ongoing lawsuit challenging the constitutionality of the individual mandate — and, ultimately, the ACA itself. A decision in that case is expected any day now.

Democrats may also seek fixes in areas such as reinsurance, outreach efforts for Obamacare exchange plans, and propose ways to promote competition in markets with few insurers. Any legislative proposals, however, would have to contend with a GOP-led Senate and White House.

Key areas to watch

Short term insurance plans, which are often less expensive but don’t meet ACA adequacy requirements, remain highly controversial.

Chen said these are part of the Trump administration’s broader strategy to implement the ACA in a way that’s more market-friendly. But Lambrew cautioned that the plans are risky since they might not carry the level of coverage someone needs when they get sick. And by luring healthy people out of the overall insurance pool, they could drive up premiums for people on ACA-complaint plans, she cautioned.

“I do think it’s a big risk to a stable insurance market when you have two parallel markets operating under different rules,” she said.

Another key areas to watch: State Innovation Waivers, which encourage states “to adopt innovative strategies to reduce future overall health care spending,” association health plans, and state-level efforts to slow rising prescription drug prices.  

A potential economic downturn and the shifting composition of state legislatures will likely keep the debate over Medicaid expansion alive, too, Chen said, as Idaho, Nebraska and Utah join the list of expansion states.

What’s next?

While the idea of a single-payer system has gotten attention in state like California, Lambrew considers such a sweeping overhaul unlikely. Taking on single payer health care would be “daunting,” she said, pointing to Vermont’s failed single-payer experiment.  

Nationally, though, the time will come for debating single payer, Chen said.  The topic will likely arise during the Democratic presidential primary, and the White House will be excited to jump into the debate, he said.

Other areas reporters should watch include potential changes to the Medicare program, such as cost sharing and changes in coverage, Lambrew said. Journalists should also keep an eye on less visible public health topics, such as maternal mortality rates and addiction prevention programs.

“There is a lot of innovation happening at the state level regardless of the fighting happening at the federal level,” she said.

 Watch the full presentation here: