What Could the Upcoming Midterm Elections Mean for Physicians and Healthcare?

Leigh Page

Disclosures

October 09, 2018

In This Article

Crucial Issues in the Upcoming Election

In the November 6 election, Democrats are likely to win the House, but Republicans are even more likely to boost their slim majority in the Senate.[1]

Democrats need to win at least 23 more seats to take control of the House, and Republicans need to expand their majority to have better control of the Senate. The GOP has its eyes on six Senate seats held by Democratic incumbents in red states.

In the campaigns, healthcare has been one of the top issues, vying with the economy, guns, taxes, and immigration. Why has healthcare become so important to voters? "It's increasingly unaffordable for the middle class," Pearl says. "Healthcare costs have been rising by 5% to 6% per year."

The level of interest in healthcare, however, differs widely by party. Whereas 33% of Democrats consider healthcare the top issue, only 15% of Republicans and 19% of independents do, according to a recent poll by the Kaiser Family Foundation.[2]

Candidates have to be careful when navigating healthcare issues. The ACA has been making a comeback in the polls, with 48% of adults having a favorable view of the law in July, but 40% still had an unfavorable view of it.[3] Pro-ACA candidates will need to win over some of those naysayers in the general election.

Many voters now believe that a single-payer health system is a better option than the ACA, but single-payer could turn out to be a sand trap for Democrats. "It gets a lot of support until you get into specifics," Pearl observes.

In a 2017 Kaiser Family Foundation survey, 53% of the public liked a single-payer system, compared with 50% liking the ACA. But when respondents were told that single-payer would require many Americans to pay more in taxes or that there would be too much government control, opposition rose from 43% to 60% and 62%, respectively.[4]

Where Are the Divisions?

Whereas Democrats are split between the ACA and a single-payer system, Republicans are split between repealing the entire ACA and saving part of it. Pearl says these splits within the parties make it all the more difficult to come up with cohesive federal healthcare policies.

The midterm election will also feature state races on the ballot, and the outcome could affect healthcare policy on the state level in such issues as health insurance regulations and changes in states' Medicaid programs.

Dominance in the states has shifted markedly toward Republicans in recent elections. The GOP currently controls 33 governorships and at least 66 chambers in the states' mostly bicameral legislatures.[5]

But that could change. The November ballot will decide 36 governorships, at least one half of state senate seats, and in most cases every house seat. As in the Congressional races, Democrats are banking on stronger candidates and greater voter enthusiasm.

One healthcare issue on the ballot involves the ACA's Medicaid expansion, where states have the option of using generous federal grants to cover more people. In state ballot resolutions, voters in Idaho, Utah, and Nebraska—three of the 18 states that have not expanded Medicaid—will opt for an expansion there.

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